血清残粒脂蛋白胆固醇是膝骨性关节炎进展的独立危险因素
Serum Remnant Lipoprotein Cholesterol Is an Independent Risk Factor for the Progression of Knee Osteoarthritis

目的：评估血脂各指标与膝骨性关节炎(OA)的关系，明确血清残粒脂蛋白胆固醇(RLP-C)与膝OA进展之间的相关性。方法：以2017年至2020年来我院就诊的OA患者为研究对象，建立OA研究队列，根据Kellgren-Lawrence分级将患者分为四个等级，收集身高、体重、病史等临床资料，测定血脂各指标，应用有序Logistic回归分析评估诱发OA进展的危险因素，应用线性趋势卡方检验评估血清RLP-C与膝OA是否线性相关。结果：共有2686名OA患者被纳入分析。随着OA分级增加，血清RLP-C水平逐渐升高，与I级OA患者相比，IV级OA患者的血清RLP-C水平增加了61.54%。甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和RLP-C均是OA进展的危险因素，而高密度脂蛋白胆固醇(HDL-C)却是阻止OA进展的保护因素。在男性人群中，与正常水平者相比，RLP-C水平升高者OA进展风险增加约3.41倍，在女性人群，这个风险增加约1.71倍，校正混杂因素后，结果仍具有统计学意义。无论在总人群，还是男性或者女性人群，OA分级与血清RLP-C水平之间呈显著线性正相关。结论：血清RLP-C水平升高是OA进展的重要独立危险因素，随着血清RLP-C水平升高，OA严重程度呈线性增加。
Objective: This study aims to assess the association between serum lipid parameters and osteoar-thritis (OA) and elucidate the correlation between remnant lipoprotein cholesterol (RLP-C) and the knee OA progression. Methods: An OA cohort was established which included all the OA patients treated in Shandong Provincial Hospital Affiliated to Shandong First Medical University from 2017 to 2020. OA was divided into four grades based on Kellgren-Lawrence classification. Height, weight, medical history, and other clinical data were collected. Serum lipid parameters were determined. Ordered logistic regression analysis was used to evaluate the risk factors of OA progression. Linear trend X² test was used to analyze the linear trend between the serum RLP-C level and the classifica-tion of OA. Results: A total of 2686 individuals were included in the final analysis. The serum RLP-C level increased with the elevation of OA classification. Compared to patients with grade I OA, the serum RLP-C level in patients with grade IV OA was 61.54% higher. Triglyceride (TG), total choles-terol (TC), and low density lipoprotein cholesterol (LDL-C) were all risk factors for the progression of OA, while high density lipoprotein cholesterol (HDL-C) was the protective factor. Compared to indi-viduals with normal RLP-C level, the risk for OA progression increased approximately 3.41-fold among subjects with high RLP-C in men and approximately 1.7-fold in women. After adjustment for confounding factors, the results were still statistically significant. A significant positive linear corre-lation between OA grade and serum RLP-C level was identified in the total population, men or women. Conclusions: High RLP-C level is an independent risk factor for the progression of OA. OA severity increased linearly with the elevation of serum RLP-C levels.