膝骨关节炎患者磁共振成像骨髓病变的检出率及其影响因素分析
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摘要
目的:研究膝骨关节炎(KOA)患者磁共振成像(MRI)骨髓病变(BML)的检出率及其影响因素。方法:选择从2015年1月到2017年12月在我院接受诊治的KOA患者182例进行研究。对患者实施MRI诊断,统计KOA患者BML的检出率及病变发生位置,并应用单因素分析和Logistic回归分析KOA患者发生BML的影响因素。结果:182例KOA患者共检出92例BML,检出率为50.55%。其中BML发生在外侧股骨、内侧股骨以及外侧胫骨、内侧胫骨的构成比均超过22.00%,检出率均超过11.00%。单因素分析显示,KOA患者发生BML与年龄、体质量指数(BMI)、病程、吸烟频率及饮酒频率等因素有关(P<0.05)。根据Logistic回归分析可知,KOA患者发生BML的影响因素主要包括年龄≥60岁、BMI≥24 kg/m2、病程≥5年、吸烟频率≥10支/d以及饮酒频率≥4次/周(P<0.05)。结论:KOA患者BML检出率较高,且影响BML发病的因素较多,临床上可从患者的年龄、BMI、病程、吸烟频率以及饮酒频率等方面进行考察,从而有助于患者病情进展的评估和后续诊治工作的进行。
Objective: To study the detection rate of bone marrow lesion(BML) with magnetic resonance imaging(MRI) and its influence factors in patients with knee osteoarthritis(KOA). Methods: A total of 182 patients with KOA, who were treated in First Affiliated Hospital of Chengdu Medical College from January 2015 to December 2017, were selected and were detected with MRI. The detection rate and location of BML in the patients with KOA were statistically analyzed. Single factor analysis and Logistic regression analysis were used to evaluate the influence factors of BML in the patients with KOA. Results: Among 182 patients with KOA,92 patients had BML, and the detection rate was 50.55%, in which, the constituent ratio of BML in lateral femur, medial femur, lateral tibia and medial tibia was more than 22.00%, the detection rate was higher than 11.00%. Single factor analysis showed that the incidence of BML in the patients with KOA was related to age, body mass index(BMI), course of disease, smoking frequency and drinking frequency(P<0.05).According to Logistic regression analysis, the main influence factors of BML in the patients with KOA were age≥60 years old, BMI≥24 kg/m2, course of disease ≥5 years, smoking frequency≥10 pieces/d and drinking frequency≥4 times/week(P<0.05). Conclusion:KOA patients have higher detection rate of BML, and there are many factors affecting the incidence of BML. It should be investigated from the aspects of age, BMI, course of disease, smoking frequency and drinking frequency, which is helpful for the evaluation of patients' progress and subsequent diagnosis and treatment.
Objective: To study the detection rate of bone marrow lesion(BML) with magnetic resonance imaging(MRI) and its influence factors in patients with knee osteoarthritis(KOA). Methods: A total of 182 patients with KOA, who were treated in First Affiliated Hospital of Chengdu Medical College from January 2015 to December 2017, were selected and were detected with MRI. The detection rate and location of BML in the patients with KOA were statistically analyzed. Single factor analysis and Logistic regression analysis were used to evaluate the influence factors of BML in the patients with KOA. Results: Among 182 patients with KOA,92 patients had BML, and the detection rate was 50.55%, in which, the constituent ratio of BML in lateral femur, medial femur, lateral tibia and medial tibia was more than 22.00%, the detection rate was higher than 11.00%. Single factor analysis showed that the incidence of BML in the patients with KOA was related to age, body mass index(BMI), course of disease, smoking frequency and drinking frequency(P<0.05).According to Logistic regression analysis, the main influence factors of BML in the patients with KOA were age≥60 years old, BMI≥24 kg/m2, course of disease ≥5 years, smoking frequency≥10 pieces/d and drinking frequency≥4 times/week(P<0.05). Conclusion:KOA patients have higher detection rate of BML, and there are many factors affecting the incidence of BML. It should be investigated from the aspects of age, BMI, course of disease, smoking frequency and drinking frequency, which is helpful for the evaluation of patients' progress and subsequent diagnosis and treatment.
引文
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[12]Kan H,Arai Y,Kobayashi M,et al.Fixed-flexion view X-ray of the knee superior in detection and follow-up of knee osteoarthritis[J].Medicine(Baltimore),2017,96(49):e9126
[13]Kim J,Lee HH,Kang Y,et al.Maximum standardised uptake value of quantitative bone SPECT/CT in patients with medial compartment osteoarthritis of the knee[J].Clin Radiol,2017,72(7):580-589
[14]Ren J,Ma J,Zhang X,et al.Diagnostic value of combined serum marker changes and quantitative MRI evaluation of cartilage volume of tibial plateau in a surgically-induced osteoarthritis dog model[J].JInt Med Res,2017,45(6):2023-2035
[15]Hada S,Ishijima M,Kaneko H,et al.Association of medial meniscal extrusion with medial tibial osteophyte distance detected by T2 mapping MRI in patients with early-stage knee osteoarthritis[J].Arthritis Res Ther,2017,19(1):201
[16]Jaremko JL,Jeffery D,Buller M,et al.Preliminary validation of the Knee Inflammation MRI Scoring System(KIMRISS)for grading bone marrow lesions in osteoarthritis of the knee:data from the Osteoarthritis Initiative[J].RMD Open,2017,3(1):e000355
[17]Nielsen FK,Egund N,J覬rgensen A,et al.Assessment of subchondral bone marrow lesions in knee osteoarthritis by MRI:a comparison of fluid sensitive and contrast enhanced sequences[J].BMC Musculoskelet Disord,2016,17(1):479
[18]Roemer FW,Guermazi A,Collins JE,et al.Semi-quantitative MRIbiomarkers of knee osteoarthritis progression in the FNIH biomarkers consortium cohort-Methodologic aspects and definition of change[J].BMC Musculoskelet Disord,2016,17(1):466
[19]Yusup A,Kaneko H,Liu L,et al.Bone marrow lesions,subchondral bone cysts and subchondral bone attrition are associated with histological synovitis in patients with end-stage knee osteoarthritis:a cross-sectional study[J].Osteoarthritis Cartilage,2015,23(11):1858-1864
[20]Kim IJ,Kim DH,Jung JY,et al.Association between bone marrow lesions detected by magnetic resonance imaging and knee pain in community residents in Korea[J].Osteoarthritis Cartilage,2013,21(9):1207-1213
[21]Lowitz T,Museyko O,Bousson V,et al.Bone marrow lesions identified by MRI in knee osteoarthritis are associated with locally increased bone mineral density measured by QCT[J].Osteoarthritis Cartilage,2013,21(7):957-964
[22]Pelletier JP,Roubille C,Raynauld JP,et al.Disease-modifying effect of strontium ranelate in a subset of patients from the Phase III knee osteoarthritis study SEKOIA using quantitative MRI:reduction in bone marrow lesions protects against cartilage loss[J].Ann Rheum Dis,2015,74(2):422-429
[23]Raynauld JP,Pelletier JP,Roubille C,et al.Magnetic Resonance Imaging-Assessed Vastus Medialis Muscle Fat Content and Risk for Knee Osteoarthritis Progression:Relevance From a Clinical Trial[J].Arthritis Care Res(Hoboken),2015,67(10):1406-1415
[24]Roemer FW,Guermazi A,Trattnig S,et al.Whole joint MRI assessment of surgical cartilage repair of the knee:cartilage repair osteoarthritis knee score(CROAKS)[J].Osteoarthritis Cartilage,2014,22(6):779-799
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[26]Bowes MA,Mc Lure SW,Wolstenholme CB,et al.Osteoarthritic bone marrow lesions almost exclusively colocate with denuded cartilage:a 3D study using data from the Osteoarthritis Initiative[J].Ann Rheum Dis,2016,75(10):1852-1857
[27]Yoo JJ,Kim DH,Kim HA.Risk factors for progression of radiographic knee osteoarthritis in elderly community residents in Korea[J].BMC Musculoskelet Disord,2018,19(1):80
[28]Berend KR,Lombardi AV Jr,Jacobs CA.The Combination of Preoperative Bone Marrow Lesions and Partial-Thickness Cartilage Loss Did Not Result in Inferior Outcomes After Medial Unicompartmental Knee Arthroplasty[J].J Arthroplasty,2017,32(10):3000-3003
[29]De Lange-Brokaar BJ,Ioan-Facsinay A,Yusuf E,et al.Evolution of synovitis in osteoarthritic knees and its association with clinical features[J].Osteoarthritis Cartilage,2016,24(11):1867-1874
[30]Zhang Y,Zeng C,Wei J,et al.Associations of cigarette smoking,betel quid chewing and alcohol consumption with high-sensitivity C-reactive protein in early radiographic knee osteoarthritis:a cross-sectional study[J].BMJ Open,2016,6(3):e010763
[2]Abdel-Aziem AA,Soliman ES,Mosaad DM,et al.Effect of a physiotherapy rehabilitation program on knee osteoarthritis in patients with different pain intensities[J].J Phys Ther Sci,2018,30(2):307-312
[3]Sit RWS,Chan KKW,Yip BHK,et al.Clinical effectiveness of patella mobilisation therapy versus a waiting list control for knee osteoarthritis:a protocol for a pragmatic randomised clinical trial[J].BMJ Open,2018,8(3):e019103
[4]Zhu Z,Jin X,Wang B,et al.Cross-Sectional and Longitudinal Associations Between Serum Levels of High-Sensitivity C-Reactive Protein,Knee Bone Marrow Lesions,and Knee Pain in Patients with Knee Osteoarthritis[J].Arthritis Care Res(Hoboken),2016,68(10):1471-1477
[5]Garg Y,Singh J,Sohal HS,et al.Comparison of Clinical Effectiveness and Safety of Newer Nonsteroidal Anti-inflammatory Drugs in Patients of Osteoarthritis of Knee Joint:A Randomized,Prospective,Open-label Parallel-group Study[J].Indian J Pharmacol,2017,49(5):383-389
[6]Titchenal MR,Williams AA,Chehab EF,et al.Cartilage Subsurface Changes to Magnetic Resonance Imaging UTE-T2*2 Years After Anterior Cruciate Ligament Reconstruction Correlate With Walking Mechanics Associated With Knee Osteoarthritis[J].Am J Sports Med,2018,46(3):565-572
[7]Tummala S,Schiphof D,Byrjalsen I,et al.Gender Differences in Knee Joint Congruity Quantified from MRI:A Validation Study with Data from Center for Clinical and Basic Research and Osteoarthritis Initiative[J].Cartilage,2018,9(1):38-45
[8]Jaremko JL,Azmat O,Lambert RG,et al.Validation of a Knowledge Transfer Tool for the Knee Inflammation MRI Scoring System for Bone Marrow Lesions According to the OMERACT Filter:Data from the Osteoarthritis Initiative[J].J Rheumatol,2017,44(11):1718-1722
[9]段临涛,王茜,胡民华,等.超声与X线、MRI影像对膝骨关节炎的诊断价值分析[J].中国超声医学杂志,2016,32(3):255-258Duan Lin-tao,Wang Qian,Hu Min-hua,et al.Comparison and Analysis on the Diagnostic Value of Ultrasound,X-ray and MRI for Knee-joint Osteoarthritis[J].Chinese Journal of Ultrasound in Medicine,2016,32(3):255-258
[10]吕苏梅,张瑞丽.中老年膝骨关节炎的流行病学研究进展[J].中国老年学杂志,2016,36(16):4133-4135Lv Su-mei,Zhang Rui-li.Progress in epidemiological study of knee osteoarthritis in the middle and old age[J].Chinese Journal of Gerontology,2016,36(16):4133-4135
[11]段虹昊,肖琳,李辉,等.全膝关节置换术与单髁置换术治疗老年膝关节骨关节炎的疗效比较[J].现代生物医学进展,2017,17(13):2463-2465,2511Duan Hong-hao,Xiao Lin,Li Hui,et al.Comparison of Clinical Efficacy of Total Knee Arthroplasty and Single Condyle Replacement in Treatment of Knee Osteoarthritis for Elderly Patients[J].Progress in Modern Biomedicine,2017,17(13):2463-2465,2511
[12]Kan H,Arai Y,Kobayashi M,et al.Fixed-flexion view X-ray of the knee superior in detection and follow-up of knee osteoarthritis[J].Medicine(Baltimore),2017,96(49):e9126
[13]Kim J,Lee HH,Kang Y,et al.Maximum standardised uptake value of quantitative bone SPECT/CT in patients with medial compartment osteoarthritis of the knee[J].Clin Radiol,2017,72(7):580-589
[14]Ren J,Ma J,Zhang X,et al.Diagnostic value of combined serum marker changes and quantitative MRI evaluation of cartilage volume of tibial plateau in a surgically-induced osteoarthritis dog model[J].JInt Med Res,2017,45(6):2023-2035
[15]Hada S,Ishijima M,Kaneko H,et al.Association of medial meniscal extrusion with medial tibial osteophyte distance detected by T2 mapping MRI in patients with early-stage knee osteoarthritis[J].Arthritis Res Ther,2017,19(1):201
[16]Jaremko JL,Jeffery D,Buller M,et al.Preliminary validation of the Knee Inflammation MRI Scoring System(KIMRISS)for grading bone marrow lesions in osteoarthritis of the knee:data from the Osteoarthritis Initiative[J].RMD Open,2017,3(1):e000355
[17]Nielsen FK,Egund N,J覬rgensen A,et al.Assessment of subchondral bone marrow lesions in knee osteoarthritis by MRI:a comparison of fluid sensitive and contrast enhanced sequences[J].BMC Musculoskelet Disord,2016,17(1):479
[18]Roemer FW,Guermazi A,Collins JE,et al.Semi-quantitative MRIbiomarkers of knee osteoarthritis progression in the FNIH biomarkers consortium cohort-Methodologic aspects and definition of change[J].BMC Musculoskelet Disord,2016,17(1):466
[19]Yusup A,Kaneko H,Liu L,et al.Bone marrow lesions,subchondral bone cysts and subchondral bone attrition are associated with histological synovitis in patients with end-stage knee osteoarthritis:a cross-sectional study[J].Osteoarthritis Cartilage,2015,23(11):1858-1864
[20]Kim IJ,Kim DH,Jung JY,et al.Association between bone marrow lesions detected by magnetic resonance imaging and knee pain in community residents in Korea[J].Osteoarthritis Cartilage,2013,21(9):1207-1213
[21]Lowitz T,Museyko O,Bousson V,et al.Bone marrow lesions identified by MRI in knee osteoarthritis are associated with locally increased bone mineral density measured by QCT[J].Osteoarthritis Cartilage,2013,21(7):957-964
[22]Pelletier JP,Roubille C,Raynauld JP,et al.Disease-modifying effect of strontium ranelate in a subset of patients from the Phase III knee osteoarthritis study SEKOIA using quantitative MRI:reduction in bone marrow lesions protects against cartilage loss[J].Ann Rheum Dis,2015,74(2):422-429
[23]Raynauld JP,Pelletier JP,Roubille C,et al.Magnetic Resonance Imaging-Assessed Vastus Medialis Muscle Fat Content and Risk for Knee Osteoarthritis Progression:Relevance From a Clinical Trial[J].Arthritis Care Res(Hoboken),2015,67(10):1406-1415
[24]Roemer FW,Guermazi A,Trattnig S,et al.Whole joint MRI assessment of surgical cartilage repair of the knee:cartilage repair osteoarthritis knee score(CROAKS)[J].Osteoarthritis Cartilage,2014,22(6):779-799
[25]Stefanik JJ,Gross KD,Guermazi A,et al.Relation of Step Length to Magnetic Resonance Imaging-Detected Structural Damage in the Patellofemoral Joint:The Multicenter Osteoarthritis Study[J].Arthritis Care Res(Hoboken),2016,68(6):776-783
[26]Bowes MA,Mc Lure SW,Wolstenholme CB,et al.Osteoarthritic bone marrow lesions almost exclusively colocate with denuded cartilage:a 3D study using data from the Osteoarthritis Initiative[J].Ann Rheum Dis,2016,75(10):1852-1857
[27]Yoo JJ,Kim DH,Kim HA.Risk factors for progression of radiographic knee osteoarthritis in elderly community residents in Korea[J].BMC Musculoskelet Disord,2018,19(1):80
[28]Berend KR,Lombardi AV Jr,Jacobs CA.The Combination of Preoperative Bone Marrow Lesions and Partial-Thickness Cartilage Loss Did Not Result in Inferior Outcomes After Medial Unicompartmental Knee Arthroplasty[J].J Arthroplasty,2017,32(10):3000-3003
[29]De Lange-Brokaar BJ,Ioan-Facsinay A,Yusuf E,et al.Evolution of synovitis in osteoarthritic knees and its association with clinical features[J].Osteoarthritis Cartilage,2016,24(11):1867-1874
[30]Zhang Y,Zeng C,Wei J,et al.Associations of cigarette smoking,betel quid chewing and alcohol consumption with high-sensitivity C-reactive protein in early radiographic knee osteoarthritis:a cross-sectional study[J].BMJ Open,2016,6(3):e010763
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