血清骨代谢标记物对预测类风湿关节炎关节破坏的意义  

The significance of serum bone metabolic markers in prediction of joint destruction in patients with rheumatoid arthritis

作　　者：杨文芳[1] 周惠琼[2] 孙晓萱[1] 张寅丽[1] 张思功[1] 彭清林[1] 王国春[1] 

机构地区：[1]中日友好医院风湿免疫科,北京100029 [2]解放军总医院第一附属医院内分泌风湿科,北京100048

出　　处：《中国骨质疏松杂志》2014年第12期1402-1406,共5页Chinese Journal of Osteoporosis

基　　金：首都临床特色应用研究(Z121107001012019)

摘　　要：目的：探讨血清骨代谢标记物与RA患者关节破坏的相关性。方法选取140例住院RA患者，90例同期健康人作为研究对象。采用DEXA测定RA者腰椎（ L1～L4）及股骨上端骨密度值，根据T值分为正常骨量、低骨量、骨质疏松组3组；另根据双手X线结果显示关节破坏程度分为Ⅰ、Ⅱ、Ⅲ、Ⅳ期组；同时检测患者血清CTX、25（ OH） D、TRACP－5b、PTH、血钙、血磷、抗CCP抗体、RF、CRP、ESR。结果 RA组TRACP－5b、CTX水平明显高于健康对照组（Z＝－2．747，－4．809，P＜0．01），25（OH）D水平明显低于健康对照组（Z＝－6．152，P＜0．001）；TRACP－5b与病程、关节压痛个数、CTX呈正相关（r＝0．193， r＝0．189， r＝0．196，P＜0．05），随着疾病活动度的加重，TRACP－5b水平呈现递增趋势，且骨质疏松组TRACP－5b水平高于正常骨量组，但未达统计学差异；CTX与关节肿胀个数、25（OH）D呈正相关（r＝0．215， r＝0．192，P＜0．05），其水平在疾病重度活动组明显高于中低度组；X线Ⅰ期组患者与其他各组相比年龄较小，病程较短，关节破坏程度轻；Ⅰ期、Ⅱ期组骨质疏松患病率明显低于Ⅲ期、Ⅳ期组（ P＜0．05）；骨量丢失随年龄增长、病程的延长、疾病活动度的加重而增加。结论骨代谢标记物与RA患者关节破坏有一定的相关性，联合检测多种骨代谢标记物可望预测关节破坏的程度。Objective To investigate the relationship between serum bone metabolic markers and joint destruction in patients with rheumatoid arthritis （ RA）.Methods One hundred and forty hospitalized RA patients and 90 healthy controls were selected as study subjects.Bone mineral density of the lumbar spine 1-4 and the proximal femus was measured using DEXA.Based on the T values, they were divided to 3 groups：normal bone mass, low bone mass, and osteoporosis group.According to X-ray reports of the extent of the joint damage, RA patients were divided into stage I, II, III, and IV groups.Serum CTX, 25 （ OH） D, TRACP-5b, PTH, serum calcium, serum phosphorus, anti-CCP antibodies, RF, CRP, and ESR were also detected.Results TRACP-5b and CTX in RA group were significantly higher than those in the control group （Z=-2.747, -4.809, P〈0.01）, but 25 （OH） D was significantly lower than that in the control group （Z=-6.152, P〈0.001）.The concentration of TRACP-5b was positively correlated with disease duration, number of joint tenderness, and CTX （r=0.193, r=0.189, r=0.196, P〈0.05）.TRACP-5b showed an increasing trend with the aggravation of disease activity, and its concentration in osteoporosis group was higher than that in normal bone mass group, but with no statistical difference.CTX was positively correlated with the number of swollen joints and 25 （OH） D （r=0.215, r=0.192, P〈0.05）, and it was obviously higher in severe disease activity group than in the middle and lower group.Compared with the other groups, patients in stage I grou had younger age, shorter duration, and less seriously joint damage.The prevalence of osteoporosis in stage I or II groups was distinctly lower than that in stage III and IV groups （P〈0.05）.＆amp;nbsp;The decrease of bone mass was positively correlated with age, duration and the aggravation of the disease activity.Conclusion There is a good correlation between bone metabolic markers and joint damage in patients with RA.The detection of multiple markers of bone

关 键 词：类风湿关节炎 关节破坏 

分 类 号：R684.3[医药卫生—骨科学]