骨代谢指标与类风湿关节炎病情活动性及骨质疏松相关性的研究  

The study of biochemical bone markers in rheumatoid arthritis:associations with disease activity and the prevalence of osteoporosis

作　　者：沈晓濛[1] 刘童[1] 徐胜前[1] 裴必伟[1] 邓娟[1] 徐建华[1] 

机构地区：[1]安徽医科大学第一附属医院风湿免疫科,合肥230032

出　　处：《中华临床医师杂志（电子版）》2012年第17期5044-5049,共6页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨骨代谢指标与类风湿关节炎(RA)病情活动性及骨质疏松(OP)的相关性。方法采用双能X线骨密度仪测定113例RA患者和120例正常对照组股骨和腰椎部位骨密度(BMD),酶联免疫吸附法(ELISA)检测血清中骨代谢指标:Ⅰ型原胶原N-端前肽(s-PINP)和血清Ⅰ型胶原交联C-末端肽(s-CTX)水平,详细记录RA患者各临床及实验室指标,对RA患者双手X线进行Sharp评分。结果 (1)RA组各部位BMD均明显低于对照组(P<0.0001),其OP发生率为31.9%,明显高于对照组(13.3%)(χ2=19.405,P<0.0001)。(2)RA组较正常组外周血s-CTX水平明显升高(Z=2.423,P<0.0015)、s-PINP水平明显降低(Z=2.264,P=0.024),s-CTX/s-PINP比值明显升高(Z=2.654,P=0.008);且重度活动组RA(78例)外周血s-CTX水平明显高于轻中度活动组(22例)(Z=2.375,P=0.035)。(3)相关性分析结果显示:RA患者外周血s-CTX水平与CRP和ESR呈正相关(P<0.05);s-CTX/s-PINP比值与关节肿胀指数和CRP呈正相关(P<0.05)。多元线性回归分析发现:病程和健康状况问卷(HAQ)与Sharp评分呈正相关(R2=0.559,F=22.791,P<0.0001)。(4)Logistic回归分析显示:s-CTX/s-PINP(OR=1.497,P=0.021,95%CI:1.061～2.113)和Sharp评分(OR=1.026,P<0.0001,95%CI:1.012～1.040)为RA患者股骨区发生OP的危险因素;年龄(OR=1.079,P=0.015,95%CI:1.015～1.148)和Sharp评分(OR=1.010,P=0.035,95%CI:1.001～1.020)为腰椎区发生OP的危险因素。结论 RA患者OP发生率显著升高,其外周血中s-PINP明显降低,s-CTX明显升高,提示骨代谢活跃;且外周血s-CTX水平、s-CTX/s-PINP比值与RA患者病情活动性和OP密切相关。Objective To investigate the relationship between serum levels of bone metabolism index and disease activity,bone mineral density(BMD)in rheumatoid arthritis(RA).Methods BMDs of the lumbar spine at Lumar 2-4(L2-4)and the femur(including Neck,Ward,G.T)was assessed in 113 patients with RA and 120 healthy controls by dual-energy X-ray absorptiometry.A panel of biomarkers of serum C telopeptide of type-Ⅰcollagen(s-CTX)and serum procollagen type-ⅠN propeptide(s-PINP)was measured by ELISA.Clinical and laboratory parameters were collected in detail and conventional radiography were scored according to the Sharp score by rhumatologue.Results(1)Patients with RA had significantly lower BMD values at all detected areas compared to controls(P<0.0001).Incidence of osteoporosis in RA was 31.9%,which was obvious higher than that in controls(13.3%)(χ2=19.405,P<0.0001).(2)The level of s-CTX(Z=2.423,P<0.015)and s-CTX/PINP ratio(Z=2.654,P=0.008)elevated significantly in RA compared to controls,whereas s-PINP(z=2.264,P=0.024)decreased largely.Concentration of s-CTX in high disease activity group of RA(n=78)was higher than that in low or moderate activity group(n=22)(Z=2.375,P=0.035).(3)Correlation analysis showed the level of s-CTX correlated with the levels of CRP and ESR which presented as a positive line correlation(P<0.05),s-CTX/s-PINP ratio positively correlated to number of swelling joint counts and CRP(P<0.05).Multiple linear regression analysis revealed that duration of disease and HAQ score correlated with Sharp score which presented as a positive line correlation(R2=0.559,F=22.791,P<0.0001).(4)Logistic regression showed that s-CTX/s-PINP(OR=1.497,P=0.021,95% CI:1.061-2.113)and Sharp score(OR=1.026,P<0.0001,95% CI:1.012-1.040)were risk factors for the occurrence of osteoporosis in RA at the site of femur,age(OR=1.079,P=0.015,95% CI:1.015-1.148)and Sharp score(OR=1.010,P=0.035,95% CI:1.001-1.020)were risk factors for the happening of osteoporosis at lumar spine.Conclusions Incidence of osteoporosis in patients with RA i

关 键 词：关节炎 类风湿 骨质疏松 Ⅰ型原胶原N-端前肽 Ⅰ型胶原交联C-末端肽 病情活动性 

分 类 号：R580[医药卫生—内分泌]