股四头肌肌内脂肪含量与膝骨关节炎患者临床严重程度之间的关系

Relationship between intramuscular fat content in the quadriceps muscle and clinical severity in patients with knee osteoarthritis

目的:探讨股四头肌肌内脂肪含量与膝骨关节炎(knee osteoarthritis,KOA)临床严重程度之间的关系。方法:选择2021年2月至2021年6月收治的30例KOA患者,男6例,女24例,年龄(64.20±9.19)岁,身体质量指数(body mass index,BMI)为(24.92±3.35) kg·m^(-2)。根据患者疼痛视觉模拟评分(visual analogue scale,VAS)的严重程度分为相对严重侧(relative severe leg,RSL)和相对较轻侧(relative moderate leg,RML),采用肌骨超声采集患者两侧股四头肌肌肉图像,再用Image J分析各肌肉的回声强度(echo intensity,EI),同时采用VAS和Western Ontario and McMaster大学骨关节炎指数(Western Ontario and McMaster Universities Osteoarthritis Index,WOMAC)评估患者的疼痛和功能情况。比较患者两侧股四头肌EI,采用Pearson相关性分析RSL与RML之间股四头肌EI值的相关性,并采用线性回归分析各肌肉EI和患者VAS、WOMAC评分之间的关系。结果:KOA患者EI值RSL侧的股外侧肌(vastus lateralis,VL)123.78±36.25和股内侧肌(vastus medialis,VM)109.46±30.36大于RML侧的108.03±31.34和93.32±26.04 (P<0.05);两侧股直肌(rectus femoris,RF)的EI值比较,差异无统计学意义(P>0.05)。两侧VL和VM的EI值呈相关性(P<0.05);RSL和RML中VM的EI值与VAS呈正相关(P<0.05);RSL中VM的EI值与WOMAC总分呈正相关(P<0.05),RML中VM和VL的EI值与WOMAC总分呈正相关(P<0.05)。结论:股四头肌肌内脂肪含量与KOA患者临床症状的严重程度密切相关,且以VM最为明显,故股四头肌肌内脂肪含量可能是评价KOA患者严重程度的客观指标。同时,降低KOA患者股四头肌肌内脂肪含量可能是防治KOA的新方向。

Objective To explore relationship between intramuscular fat content of quadriceps femoris and clinical severity of knee osteoarthritis(KOA).Methods Totally 30 KOA patients were selected from February 2021 to June 2021 including 6males and 24 females,aged with an average of(64.20±9.19) years old,and body mass index(BMI) was(24.92±3.35) kg·m~(-2).Patients were divided into relative severe leg(RSL) and relative moderate leg(RML) according to severity of pain on visual analogue scale(VAS).Musculoskeletal ultrasound was used to collect muscle images of quadriceps muscles on both sides of the patient,and Image J was used to analyze echo intensity(EI) of each muscle.Both VAS and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) were used to assess pain and function.Quadriceps muscle EI on both sides of patients was compared.Pearson correlation analysis was conducted to analyze correlation between quadriceps muscle El value between RSL and RML,and linear regression was used to analyze relationship between each muscle El and VAS and WOMA scores of patients.Results The EI of RSL lateral vastus lateralis(VL) was 123.78±36.25 and RSL vastus medialis(VM) was109.46±30.36 which were significantly higher than those of 108.03±31.34 and 93.32±26.04 of RML(P<0.05),but there was no statistical significance in EI values of rectus femoris(RF) on both sides(P>0.05).EI values of VL and VM on both sides were significantly correlated(P<0.05).There was a significant positive correlation between VM EI value and VAS score in RSL and RML(P<0.05).VM EI values in RSL were positively correlated with total WOMAC(P<0.05),and VM VL EI values in RML were positively correlated with total WOMAC score(P<0.05).Conclusion Intramuscular fat content of quadriceps is closely related to severity of clinical symptoms in KOA patients,and the most obvious one is VM.Therefore,the intramuscular fat content of quadriceps may be an objective indicator to evaluate severity of KOA patients.At the same time,reducing intramuscular fat content of the quadriceps muscle of KOA patients may be a new direction for the prevention and treatment of KOA.