类风湿性关节炎合并骨质疏松的老年患者骨转换生化标志物水平的研究  

Study of the levels of biochemical bone turnover markers in elderly patients with rheumatoid arthritis combined with osteoporosis

作　　者：王文娇[1] 王亮[1] 马远征[1] 白颖[1] 陈琼[1] 马伟凤[1] 杨帆[1] 谢媛媛[1] 

机构地区：[1]解放军第309医院骨科中心骨内科,北京100091

出　　处：《中国骨质疏松杂志》2015年第12期1441-1444,共4页Chinese Journal of Osteoporosis

基　　金：全军十二五课题(CWS11J169)

摘　　要：目的探讨类风湿性关节炎合并骨质疏松的老年患者骨转换生化标志物的水平。方法选择2008年1月至2014年4月在我科住院的73例患者,包括类风湿性关节炎合并骨质疏松患者35例,年龄(64.51±13.27)岁,原发性骨质疏松患者38例,年龄(65.42±8.86)岁。采用美国Norland双光能X线骨密度检测仪对所有患者进行腰椎L2-4和左侧股骨近端(包括Neck、Troch、Ward’s三角区)骨密度测量,并测定身高、体重、血谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐(CRE)、尿素氮(BUN)。采用酶联免疫吸附法测定两组患者血清骨钙素(OC)、骨特异性碱性磷酸酶(BAP)、I型胶原交联C-末端肽(SCTX),比较两组血清OC、BAP、S-CTX水平。结果类风湿性关节炎合并骨质疏松组患者骨形成指标血清OC(13.5654±8.8701)ng/ml,较原发性骨质疏松患者(9.3113±6.7816)ng/ml高,差异具有统计学意义(P<0.05);类风湿性关节炎合并骨质疏松组患者骨形成指标BAP(15.7274±5.3279)ug/l,与原发性骨质疏松患者(16.7539±7.0390)ug/l相比无统计学意义(P>0.05);类风湿性关节炎合并骨质疏松组患者骨吸收指标S-CTX(0.7746±0.7149)ng/ml,比原发性骨质疏松患者(0.3346±0.1668)ng/ml高,差异具有统计学意义(P<0.05);类风湿性关节炎合并骨质疏松组患者身高(162.60±6.87)cm、体重(60.54±9.87)kg、ALT(20.19±16.56)IU/L、AST(20.09±10.41)IU/L、CRE(64.55±19.51)umol/L、BUN(5.75±1.97)mmol/L,与原发性骨质疏松组身高(161.92±9.33)cm、体重(64.85±11.86)kg、ALT(23.91±15.87)IU/L、AST(21.32±8.72)IU/L、CRE(63.79±13.4260)umol/L、BUN(5.27±1.60)mmol/L相比,差异无统计学意义(P>0.05);类风湿性关节炎合并骨质疏松患者L2-4、Neck、Troch、Ward’s三角区的骨密度分别为(0.8600±0.1637)g/cm2、(0.6840±0.0.1355)g/cm2、(0.5831±0.1225)g/cm2、(0.5181±0.1304)g/cm2,与原发性骨质疏松组(0.8744±0.1668)g/cm2、(0.7426±0.1686)g/cm2、(0.5995±0.1088)g/cm2、(0.5459±0.1088)g/cm2相比,差异没有统计Objective To study thelevels of biochemical boneturnover markers in elderly patients with rheumatoid arthritis combined with osteoporosis. Methods Seventy-threecases who attended in our hospital from Jan. 2008 to Apr. 2014 wereselected,including 35 patients（ 64. 51 ± 13. 27 years old） with rheumatoid arthritis combined with osteoporosis and 38 patients（ 65. 42 ± 8. 86 years old） with primary osteoporosis. Bonemineral density of L2-L4 and theleft femurs（ neck,Troch,and Ward＇s triangle） weremeasured using dual energy X-ray absorptiometry（ DEXA）. Theheight,body weight,ALT,AST,CRE,and BUN wereexamined. Osteocalcin（ OC）,bone-specific alkalinephosphatase（ BAP）,and typeI collagen cross-linking C terminal peptide（ S-CTX） weremeasured with enzymelinked immunosorbent assay and thelevels of bonemarkers werecompared. Results Theboneformation marker OC was higher in patients with rheumatoid arthritis combined with osteoporosis（ 13. 5654 ± 8. 8701 ng /ml） than that in control group（ 9. 3113 ± 6. 7816 ng / ml）,with statistical significance（ P〈0. 05）. Theboneformation marker BAP was not statistically different between patients with rheumatoid arthritis combined with osteoporosis（ 15. 7274 ± 5. 3279 ug / l） and in control group（ 16. 7539 ± 7. 0390 ug / l,P〈0. 05）. Theboneresorption marker S-CTX was higher in patients with rheumatoid arthritis combined with osteoporosis（ 0. 7746 ± 0. 7149 ng / ml） than that in control group（ 0. 3346 ± 0. 1668 ng / ml）,with statistical difference（ P〈0. 05）. Theheight,weight,ALT,AST,CRE,and BUN in patients with rheumatoid arthritis combined with osteoporosis（ 162. 60 ± 6. 87 cm,60. 54 ± 9. 87 kg,20. 19 ± 16. 56 IU / L,20. 09 ± 10. 41 IU / L,64. 55 ± 19. 51 umol / L,and 5. 75± 1. 97 mmol / L,respectively） werenot different compared to thosein control group（ 161. 92 ± 9. 33 cm,64. 85 ± 11. 86 kg,23. 91 ± 15. 87 IU / L,21. 32 ± 8. 72 IU / L,63. 79 ± 13. 4260 umol / L,and 5. 27 ± 1. 60 mmol / L,respectively）.

关 键 词：类风湿性关节炎 骨质疏松 骨转换生化标志物 骨钙素 骨特异性碱性磷酸酶 I型胶原交联C-末端肽 

分 类 号：R593.22[医药卫生—内科学] R589.5[医药卫生—临床医学]