类风湿关节炎不同疾病活动度下骨代谢指标的变化  

Changes of bone metabolism in rheumatoid arthritis with different disease activities

作　　者：王鑫[1] 俞钟明[1] 孙佳颖 WANG Xin;YU Zhongming;SUN Jiaying(Department of Rheumatology,Shaoxing People＇s Hospital,Shaoxing 312000,China)

机构地区：[1]绍兴市人民医院风湿科,312000

出　　处：《浙江医学》2018年第22期2462-2465,2469,共5页Zhejiang Medical Journal

摘　　要：目的分析类风湿关节炎(RA)患者不同疾病活动度下骨代谢指标的变化,为探讨RA引起骨质疏松(OP)的机制及治疗提供理论依据。方法选取RA患者100例作为RA组,健康体检者60例作为健康对照组。采用ELISA法检测两组血清骨钙素(BGP)、25羟维生素D[25(OH)D]、骨桥蛋白(OPN)、骨特异性碱性磷酸酶(BALP)、抗酒石酸酸性磷酸酶异构体5b(TRACP-5b)等骨代谢指标并进行比较。采用疾病活动度评分(DAS28)对RA患者进行病情评估,比较不同疾病活动度下患者一般情况[性别、年龄、ESR、C反应蛋白(CRP)]、骨密度、骨代谢指标的差异;分析DAS28与骨代谢指标的相关性。结果 RA患者OP发生率为32.00%,骨量减少发生率为52.00%。RA组患者血清ESR、CRP、BGP、OPN、BALP、TRACP-5b水平均较健康对照组升高,血清25(OH)D水平较健康对照组降低,差异均有统计学意义(均P<0.01)。重度活动度组患者血清BGP、OPN、BALP、TRACP-5b水平均较中度活动度组升高,血清OPN、BALP、TRACP-5b水平均较病情稳定及低度活动度组均升高,中度活动度组患者血清OPN水平较病情稳定及低度活动度组升高,差异均有统计学意义(均P<0.05)。RA患者DAS28与血清BGP、OPN、BALP、TRACP-5b水平均呈正相关(r=0.345、0.403、0.408和0.454,均P<0.05),与血清25(OH)D水平呈负相关(r=-0.237,P<0.05)。结论RA患者血清BGP、OPN、BALP、TRACP-5b水平均升高,且与DAS28均呈正相关。尽早控制RA病情进展可以预防OP的发生。Objective To investigate the changes of bone metabolism in patients with rheumatoid arthritis （RA） of different disease activities. Methods One hudred RA patients （RA group）, and 60 healthy subjects （control group） were included in the study. The serum bone metabolism markers including osteocalcin （BGP）, 25（OH）D, osteopontin （OPN）, bone specific alkaline phosphatase （BALP） and tartaric acid phosphatase isomers 5b （TRACP-5b） were measured by ELISA. Disease activity scale （DAS28） was used to evaluate patients with RA, and the gender, age, ESR, CRP, bone mineral density （BMD） and bone metabolism markers were compared in RA patients with different disease activity. The correlation between bone metabolism index and DAS28 score was analyzed. Results The incidence rates of osteoporosis （OP）, low BMD were 32.00% and 52.00% in RA patients, respectively. The levels of ESR, CRP, BGP, OPN, BALP and TRACP-5b were significantly higher, and the levels of 25（OH）D were lower in RA group than those in healthy control group （all P〈0.01）. According to DAS28, the serum BGP, OPN, BALP and TRACP-5b in the severe disease activity group were higher than those in the moderate disease group, the serum OPN, BALP and TRACP-5b in the severe disease activity group were higher than those in the mild disease group, the serum OPN in the moderate disease activity was higher than the mild activity group, the differences were statistically significant （all P〈0.05）. DAS28 was positively correlated with serum BGP, OPN, BALP and TRACP-5b （r=0.345, 0.403, 0.408 and 0.454, all P〈0.05）, and was negatively correlated with 25（OH）D （r=-0.237, P〈0.05）. Conclusion The serum levels of BGP, OPN, BALP and TRACP-5b are elevated in RA patients. DAS28 is associated with bone metabolism, indicating that early control of RA may improve bone metabolism and prevent OP in RA patients.

关 键 词：类风湿关节炎 骨质疏松 骨代谢 DAS28 

分 类 号：R593.22[医药卫生—内科学] R580[医药卫生—临床医学]