课件：OA治疗新进展.ppt

美国男性和女性的手OA无论是症状性还是放射学OA，均高于中国人。 中国女性DIP和PIP的OA患病率高于男性，但拇指根部和MCP的OA患病率低于男性。 和美国人相比，中国人DIP、PIP和拇指根部OA的患病率均较低，在MCP两国 OA的患病率相似。 Compared with Chinese men, Chinese women had a much higher prevalence of OA at the DIP and PIP joints, but a lower prevalence of OA at the thumb base and MCP joint. The pattern of joint involvement in hand OA was quite different between the Chinese and whites. Prevalence of OA in the DIP, PIP, and thumb-base joints was much lower among Chinese in Beijing than that among whites in Framingham; however, occurrence of symptomatic OA at the MCP joints in Chinese men and radiographic OA at the MCP joints in Chinese women were comparable with those in their counterparts in the US. 无论是男性还是女性，中国人髋OA的患病率显著低于美国白人。 国人，女性只有2例症状OA，男性 0例 OA的准确病因，至今不清楚。肯定是遗传因素与环境因素共同作用的结果，环境因素起的作用可能还要大一点。 已经证明年龄增加与机械负荷是OA最主要的危险因素。女性较男性易患OA，关节外伤也促进OA的发生。 OA的发病机制主要涉及：软骨细胞合成ECM减少，软骨细胞和滑膜细胞产生MMPs增加，软骨细胞凋亡和 软骨细胞衰老。 症状性OA往往伴有慢性滑膜炎，病理改变包括衬里层细胞增生、淋巴细胞的浸润及血管周围的淋巴细胞聚集，在关节腔内还可以形成显著的绒毛，从关节表面脱落的关节软骨碎片被滑膜包裹，随后被巨噬细胞呑噬。但与RA不同，炎症程度相对较轻，滑膜衬里层细胞一般不侵蚀关节边缘的软骨。很少在关节软骨表面出现血管翳浸润。 关节韧带的变化有血管扩张、组织水肿等，纤维组织增生可累及到神经束膜和神经内膜。 Figure 1. Synovial tissues from patients with a, fracture, b, early rheumatoid arthritis (RA), and c, osteoarthritis (OA). Proliferation of lining cells with vessels is present in the samples from the patient with early RA and the patient with OA (arrows), whereas the lining cells are arranged as a monolayer in the sample from the patient with fracture (arrowhead). (Meyer’s hematoxylin and eosin stained; original magnification 50.) 但日本Nishioka研究小组报道，OA也有血管翳，组织学照片可以看到，---， 进一步放大后，可以看得更清楚。 Fig. 1. A macroscopic finding of the knee joint specimen from a 77-year-old female. (a) As many sections as possible were resected from articular fragment obtained during arthroplasty. Specimens were resected along dotted line. T: tibia, F: femur, P: patella. (b) Cut section of cartilage sample covered with pannuslike tissue. Arrows indicate pannus-like tissue. Fig. 2. Histological findings of pan