类风湿关节炎患者血清骨形态发生蛋白6和铁调素与贫血的关系  

Association of serum bone morphogenetic protein-6 and hepcidin levels with anemia in patients with rheumatoid arthritis

作　　者：邬秀娣[1] 张振[1] 陈勇[1] 谢斌华[1] 干敏芝[1] 黄娴倩[1] 刘磊[1] 

机构地区：[1]宁波市第二医院风湿免疫科,315010

出　　处：《浙江医学》2013年第18期1632-1636,共5页Zhejiang Medical Journal

基　　金：宁波市自然科学基金(2013A610265)

摘　　要：目的探讨类风湿关节炎(RA)患者骨形态发生蛋白6(BMP-6)和铁调素(Hepc)与贫血的关系。方法采用酶联免疫吸附法测定99例RA患者、19例系统性红斑狼疮(SLE)患者、40例健康志愿者的血清BMP-6、Hepc水平,同时检测RA患者的红细胞计数(RBC)、血红蛋白水平(HGB)、白细胞介素6(IL-6)、血清铁(SI)、血清可溶性转铁蛋白受体(sTfR)、铁蛋白(SF),分析比较RA组与SLE组和健康对照组、RA患者贫血组与非贫血组、慢性病性贫血(ACD)与慢性病伴缺铁性贫血(IDA+ACD)组间及不同疾病活动度组间BMP-6、Hepc和其他贫血相关指标,以及RA患者血清BMP-6和Hepc水平与其他因素间的相关性。结果 RA患者贫血发生率为59.6%,其中ACD占52.5%,IDA+ACD占47.5%。血清BMP-6和Hepc水平在RA患者中明显升高,与SLE组、健康对照组的差异均有统计学意义(均P<0.05)。RA贫血组的IL-6水平及类风湿关节炎疾病活动性评分(DAS28)较非贫血组均明显升高,差异有统计学意义(P<0.05),而两者SI、SF、BMP-6和Hepc水平的差异均无统计学意义(均P>0.05);RA伴ACD患者的血清SF、Hepc、BMP-6水平及DAS28评分均明显高于RA伴IDA+ACD组,差异均有统计学意义(均P<0.05)。DAS28>5.1的RA疾病高度活动组血清BMP-6及Hepc较DAS28评分≤5.1的疾病非高度活动组明显升高,而HGB水平明显降低,差异均有统计学意义(均P<0.05)。RA患者的血清BMP-6与Hepc水平呈正相关(P<0.01),且两者均与IL-6、DAS28呈正相关(P<0.05),BMP-6还与SI呈正相关(P<0.05)。结论 RA患者贫血类型以ACD为主,其血清BMP-6和Hepc水平均明显升高,在伴ACD或疾病高度活动的RA患者中升高尤其明显,且互相关系密切,说明BMP-6和Hepc水平异常正是诱导RA患者发生ACD的主要因素之一,两者可能可以作为RA患者ACD治疗的靶点,其在RA中的作用机制值得进一步研究探索。Objective To investigate the association of serum bone morphogenetic protein- 6 （BMP- 6） and hepcidin （Hepc） levels with anemia in patients with rheumatoid arthritis（RA）. Methods Blood samples were col ected from 99 patients with RA,19 patients with systemic lupus erythematosus （SLE） and 40 healthy controls. Serum BMP- 6, Hepc and IL- 6 were measured by ELISA, and serum iron（SI）, ferritin（SF）, soluble transferrin receptor（sTfR） levels were also determined. The correlation of BMP- 6 and Hepc levels with anemia and disease activity score for 28 joints（DAS28） was analyzed by SPSS software. Results In 99 RA patients, 59 （59.6%） were complicated with anemia, including 30 patients （52.5%） with anemia of chronic disease （ACD） having sTfR/logSF index value〈1.5, and 29 （47.5%） with anemia of chronic disease and coexistent iron deficiency anemia （ACD＋IDA） having sTfR/logSF index value≥1.5. Serum BMP- 6 and Hepc levels in RA patients were higher than those in healthy controls or SLE （P〈0.05）. DAS28 scores and serum IL- 6 were higher in anemic RA patients than in RA patients without anemia （P〈0.05）, but no differences were observed in levels of SI, SF, BMP- 6 and Hepc between two groups. The levels of SF, BMP- 6, Hepc and DAS28 score was higher in RA patients with ACD than those in RA patients with ACD＋IDA（P〈0.05）. Hemoglobin levels in RA pa-tients with high DAS28 scores （〉5.1） were lower than those with low DAS28 scores （≤5.1）, while serum BMP- 6 and Hepc levels were higher in RA patients with high DAS28 scores than those with low DAS28 scores（P〈0.05）. In RA patients, the level of serum BMP- 6 was positively correlated with Hepc, IL- 6, SI and DAS28 scores （P〈0.01）. And the level of serum Hepc was positively correlated with IL- 6 and DAS28 scores（P〈0.05）. Conclusion The serum levels of BMP- 6 and Hepc are high in RA patients, es-pecial y in patients with ACD or high DAS28 scores. The correlation between BMP- 6, Hepc a

关 键 词：类风湿关节炎 铁调素 骨形态发生蛋白6 贫血 

分 类 号：R593.22[医药卫生—内科学]