滑膜炎在BMI和全膝关节置换术风险之间的中介效应  

Mediating effect of synovitis in the association between BMI and the risk of total knee replacement

作　　者：丁煜堃 张鑫涛 张晓东 DING Yukun;ZHANG Xintao;ZHANG Xiaodong(Department of Medical Imaging,the Third Affiliated Hospital of Southern Medical University(Academy of Orthopedics Guangdong Province),Guangzhou 510630,China)

机构地区：[1]南方医科大学第三附属医院(广东省骨科研究院)影像科,广州510630

出　　处：《磁共振成像》2023年第3期122-127,139,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：南方医科大学第三附属医院院长基金项目(编号:YM2021012)。

摘　　要：目的探究滑膜炎在体质量指数(body mass index,BMI)和全膝关节置换术(total knee replacement,TKR)风险之间的中介效应。材料与方法本研究的数据源于骨性关节炎倡议(Osteoarthritis Initiative,OAI)。根据基线时的年龄(±5岁)、性别和Kellgren–Lawrence分级,将OAI参与者在12~60个月随访时接受TKR的膝关节(病例)与对照膝关节(60个月内未接受TKR)进行1∶1匹配,纳入450个和376个膝关节用于基线和T0时(接受TKR的前一个随访时间点)的研究。根据MRI骨性关节炎膝关节评分(MRI Osteoarthritis Knee Score,MOAKS)对积液性滑膜炎和Hoffa滑膜炎进行半定量评分。条件logistic回归评价BMI和TKR风险之间的相关性。中介效应分析用于评估滑膜炎的中介作用。结果纳入基线研究的参与者年龄为(65.0±9.0)岁,59.2%为女性,84.9%为白种人。病例组在基线和T0时的积液性滑膜炎和Hoffa滑膜炎的患病率均高于对照组;而只有在T0时,BMI与积液性滑膜炎的患病率(χ^(2)=9.173,P=0.010)和得分(χ^(2)=22.371,P=0.001)之间存在统计学上的关联。在控制既往膝关节受伤后,BMI与TKR风险有关(OR=1.121,95%CI:1.070~1.175,P<0.001);并且T0时的积液性滑膜炎在BMI和TKR风险之间的中介效应显著,中介效应为0.0298(95%CI:0.0132~0.0506),效应占比为22.61%。结论本研究首先表明T0时的积液性滑膜炎介导了BMI和TKR风险之间的关系,重视超重或肥胖人群积液性滑膜炎的MRI精准评估并及时干预,有助于指导临床降低未来一年内的TKR发生风险。Objective:To investigate the mediating effect of synovitis in the association between body mass index(BMI)and the risk of total knee replacement(TKR).Materials and Methods:Case knees from the Osteoarthritis Initiative(OAI)participants with TKR at 12-60 months follow up were 1∶1 matched with control knees(no TKR throughout 60 months)by baseline age(±5 years),sex and Kellgren-Lawrence grade.Total 450 and 376 knees were included for the studies at baseline and at T0(the previous follow-up before receiving TKR was termed as T0).According to the MRI Osteoarthritis Knee Score(MOAKS),effusion-synovitis and Hoffa-synovitis were scored semi-quantitatively.Conditional logistic regression estimated the correlation between BMI and TKR.Mediation analysis was used to evaluate the mediating effects of synovitis.Results:The mean age of participants included for the study at baseline was(65.0±9.0)years,59.2%were female,and 84.9%were White.The prevalence of effusion synovitis and Hoffa-synovitis at baseline and at T0 was higher in the case group than in the control group.Only at T0,there was a statistically significant associations between BMI with prevalence(χ^(2)=9.173,P=0.010)and score(χ^(2)=22.371,P=0.001)of effusion synovitis.After controlling for prior knee injury,BMI was associated with the risk of TKR(OR=1.121,95%CI:1.070-1.175,P<0.001);effusion synovitis at T0 had a significant mediating effect on BMI and TKR,indirect effect coefficient was 0.0298(95%CI:0.0132-0.0506),and the mediating contribution rate was 22.61%.Conclusions:Our study is the first to indicate that effusion synovitis at T0 mediated the association between BMI and the risk of TKR.Attaching importance to MRI accurate evaluation and timely intervention of effusion synovitis in overweight or obese people is helpful to guide clinical practice to reduce the risk of TKR within the next year.

关 键 词：滑膜炎 骨性关节炎 体质量指数 全膝关节置换术 中介效应 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R686.7[医药卫生—诊断学] R687.4[医药卫生—临床医学]