VitK與骨關(guān)節(jié)炎相關(guān)性研究進(jìn)展

1、VitK與骨關(guān)節(jié)炎相關(guān)性研究進(jìn)展膝關(guān)節(jié)OA是全球老年致殘的首因手、膝、髖關(guān)節(jié)為常見OA部位膝關(guān)節(jié)OA是全球老年致殘的首因60歲以上人群，9.6%男性和18%女性存在癥狀性O(shè)A1.Duarte Pereira, et al. Acta Med Port. 2015;28(1):99-106.2.Woolf A D, Pfleger B. Burden of major musculoskeletal conditions.J. Bulletin of the World Health Organization, 2003, 81(9):646-656.手關(guān)節(jié) 2-77.1%膝關(guān)節(jié) 6.3-68.

2、4%髖關(guān)節(jié) 0.9-23%9.6%18%骨關(guān)節(jié)炎指南：OA階梯治療理念基礎(chǔ)治療（患者教育、運(yùn)動(dòng)治療、物理治療、行動(dòng)支持治療）藥物治療（鎮(zhèn)痛藥物、關(guān)節(jié)腔注射藥物、緩解癥狀的慢作用藥物、中藥）恢復(fù)性治療（關(guān)節(jié)鏡手術(shù)、軟骨修復(fù)手術(shù)、力線矯正手術(shù)等）重建治療（關(guān)節(jié)置換術(shù)）骨關(guān)節(jié)炎的藥物治療現(xiàn)狀2012ACR2013AAOS2014 NICE2014 OARSI2014ESCEO2016PANLAR2018EULAR2018中國(guó)指南口服或局部使用NSAIDs對(duì)乙酰氨基酚曲馬多-*-阿片類藥物-氨基葡萄糖和/或硫酸軟骨素（緩解癥狀）（延緩病情）關(guān)節(jié)腔內(nèi)注射糖皮質(zhì)激素透明質(zhì)酸（膝OA）（多關(guān)節(jié)OA）-：推薦

3、； ：不推薦； ：不確定； -：未提及 *曲馬多包含在阿片類藥物中介紹，所以推薦等同于阿片類藥物骨關(guān)節(jié)炎的食物補(bǔ)充劑治療Liu X, et al. Br J Sports Med 2017;0:110維生素K2促進(jìn)骨鈣沉積維生素K與骨關(guān)節(jié)炎相關(guān)的機(jī)制Loeser RF, etal. Ann Rheum Dis May 2021維生素K與骨關(guān)節(jié)炎相關(guān)的證據(jù)華法林使用增加膝或髖置換術(shù)風(fēng)險(xiǎn)Ballal P, et al. Ann Rheum Dis, 2021;80:605609.維生素K與骨關(guān)節(jié)炎相關(guān)的證據(jù)維生素K拮抗劑使用增加膝關(guān)節(jié)患病率Boer CG, et al. Ann Rheum Dis

4、, 2021;80:598604.既往維生素K與OA相關(guān)研究概況Author NStudy designShea MK 791Prospective Misra D1180Prospective design using a MOST cohort dataMisra D376Longitudinal designed study using a RCT population of hand OA, yet analyzing the cross-sectional associationsBing W 178+160Case-control studyOka H 719Cross-secti

5、onal study using population-based cohort study supports of knee OANeogi T 672Cross-sectional study in a population-based prospective observational cohort of Framingham Offspring StudyNaito K 25Case-control studyNeogi T378Prospective RCT既往維生素K與OA相關(guān)研究主要結(jié)果（橫斷面或病例對(duì)照研究）Author ResultsShea MK Higher plasma

6、 (dp)ucMGP (reflective of lower vitamin K status) was associated with higher odds of meniscus damage, osteophytes, bone marrow lesions, and subarticular cystsBing W Serum ucMGP level of the knee OA patients was significantly lower than that of healthy controls. Synovial fluid ucMGP level was negativ

7、ely correlated with radiographic severityOka H Vitamin K intake was inversely associated with the prevalence of radiographic knee OA and the presence of joint space narrowing of knee.Neogi T The PRs for OA, osteophytes, and JSN and adjusted mean number of joints with all 3 features in the hand decre

8、ased significantly with increasing plasma phylloquinone levelsNaito K Serum ucOC was elevated in OA patients. Serum ucOC was correlated with markers for bone metabolism (s-NTx, s-BAP) and synovitis (s-HA)既往維生素K與OA相關(guān)研究主要結(jié)果（前瞻性研究及RCT）Author ResultsShea MK Very low plasma vitamin K (1 nmol/L) at follow

9、-up may have had a benefit in joint space narrowing.我們的研究研究目的及方法研究目的：探討VitK攝入與膝骨關(guān)節(jié)炎癥狀及結(jié)構(gòu)改變的相關(guān)性研究方法研究人群：VIDEO研究的分中心入組人群VitK數(shù)據(jù)來(lái)源：入組對(duì)象基線期填寫食物量表中提取VitK攝入數(shù)據(jù)OA轉(zhuǎn)歸指標(biāo)：WOMAC量表，MRI結(jié)構(gòu)指標(biāo)（軟骨缺損、骨髓水腫，滲液量）研究方法維生素K攝入量采用四分位校正年齡、性別、BMI、VitD分組、食物健康指數(shù)評(píng)分、活動(dòng)指數(shù)、NSAID使用主要結(jié)果基線vitK攝入四分位高的患者，24個(gè)月時(shí)WOMAC總分和功能評(píng)分下降更多 (P=0.046及0.03)

10、 基線OA癥狀更嚴(yán)重患者(VAS60mm)，基線vitK攝入四分位更高的患者在24個(gè)月時(shí)WOMAC總分、疼痛評(píng)分、晨僵評(píng)分、功能評(píng)分下降更多整體上vitK攝入與24個(gè)月MRI結(jié)構(gòu)評(píng)分變化沒有相關(guān)；但在基線癥狀嚴(yán)重者、基線放射學(xué)嚴(yán)重者及女性，vitK攝入與總軟骨缺損評(píng)分、脛股關(guān)節(jié)及髕骨關(guān)節(jié)軟骨缺損評(píng)分的24個(gè)月下降幅度呈正相關(guān)VAS grade subgroupMild/moderate(n=140)Severe(n=72)Multivariable*, (95%CI)P valueMultivariable*, (95%CI)P valueTotal WOMAC Score Vitamin K

11、 intake quartile 1Reference Reference Vitamin K intake quartile 290.83(-95.6, 277.2)0.337-246.1(-550.3, 58.0)0.111Vitamin K intake quartile 3-14.6 (-200.0, 170.9)0.877-487.0 (-793.6, -180.3)0.002Vitamin K intake quartile 468.1 (-111.4, 247.6)0.454-533.5 (-859.1, -207.8)0.002P for trend 0.737 0.000WO

12、MAC Pain Score Vitamin K intake quartile 1Reference Reference Vitamin K intake quartile 228.2 (-16.0, 72.4)0.210-52.0 (-133.5, 29.5)0.207Vitamin K intake quartile 30.6 (-43.1, 44.2)0.980-139.0 (-221.1, -56.8)0.001Vitamin K intake quartile 436.4(-5.8, 78.6)0.090-97.3(-184.6, -10.1)0.029P for trend 0.

13、223 0.005WOMAC Stiffness Score Vitamin K intake quartile 1Reference Reference Vitamin K intake quartile 210.9(-8.3, 30.1)0.264-29.2 (-63.8, 5.4)0.097Vitamin K intake quartile 35.7(-13.4, 24.8)0.556-59.0 (-93.8, -24.1)0.001Vitamin K intake quartile 411.4(-6.9, 29.8)0.220-61.3 (-98.3, -24.2)0.002P for

14、 trend 0.333 0.001WOMAC Function Score Vitamin K intake quartile 1Reference Reference Vitamin K intake quartile 251.2(-86.1, 188.6)0.462-165.0 (-373.9, 44.0)0.120Vitamin K intake quartile 3-22.4 (-159.0, 114.2)0.746-289.0(-499.7, -78.4)0.008Vitamin K intake quartile 417.5(-114.7, 149.8)0.793-374.9 (

15、-598.6, -151.2)0.001P for trend 0.911 0.001 (95% CI)* Total TibiofemoralPatellar Baseline VAS grade of study knee Mild/moderate,(n=135)0.123(-0.29,0.53)0.007(-0.33,0.35)0.039(-0.13,0.20)Severe,(n=71)-1.157(-2.08, -0.23)-0.599(-1.24, 0.04)-0.463(-0.67, -0.26)Baseline radiographic grade No, n=1090.46(-0.04,0.97)0.19 (-0.25,0.55)0.07(-0.14,0.28)Yes, n=97-1.17(-1.87, -0.46)-0.59(-1.11, -0.06)-0.36(-0.52, -0.19)Gender Male, n=1110.30(-0.25, 0.84)-0.02(-0.42, 0.37)0.18(0.00, 0.35)Female, n=95-0.86(-1.47, -0.26)-0.29(-0.77, 0.20)-0.44(-0.62, -0.25 )Associations between vitamin K inta