抗瓜氨酸蛋白抗体与类风湿关节炎继发骨质疏松的相关性  

Correlation between anti-citrullinated protein antibodies and osteoporosis secondary to rheumatoid arthritis

作　　者：张佳琦 鲁芙爱 张文兰[1] 王永福[1] ZHANG Jiaqi;LU Fuai;ZHANG Wenlan;WANG Yongfu(Department of Rheumatology,the First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology,Institution of Immunology and Rheumatology,Baotou Medical College,Inner Mongolia Key Laboratory of Autoimmunity,Baotou 014010,China)

机构地区：[1]内蒙古科技大学包头医学院第一附属医院风湿免疫科,包头医学院风湿免疫研究所,内蒙古自体免疫学重点实验室,内蒙古包头014010

出　　处：《中国骨质疏松杂志》2022年第8期1115-1120,共6页Chinese Journal of Osteoporosis

基　　金：国家自然科学基金(81860295);内蒙古自治区自然科学基金(2019MS08055)。

摘　　要：目的分析ACPAs抗体(主要是AMCV和ACCP)与类风湿关节炎(rheumatoid arthritis,RA)患者继发骨质疏松以及与骨密度、骨代谢指标的相关性。方法根据纳入标准及排除标准选取内蒙古科技大学包头医学院第一附属医院就诊的591例RA患者,详细记录患者的临床资料。采用ELISA法检测AMCV、ACCP、三种亚型RF以及骨代谢指标PINP、β-CTX、N-MID OC和25HVD;采用DXA检测RA患者髋关节及腰椎的BMD、BMC、Z值和T值;采用SPSS 20软件进行统计分析。结果AMCV、ACCP阳性组较阴性组比较,IgA、IgM、三种亚型RF水平高,25HVD水平低。PINP、N-MID OC与病程呈正相关,骨密度指标与病程呈负相关;25HVD与ACCP、AMCV、三种亚型RF呈负相关。PINP和N-MID OC水平随病程增加而升高,25HVD和骨密度指标水平随病程增加而下降。骨质疏松组与骨量正常组和骨量减少组相比较,RA患者的年龄更大,病程更长,三种亚型RF水平更高。结论ACPAs抗体与RA患者25HVD呈负相关;RA患者的骨密度及骨代谢与病程呈负相关;继发骨质疏松的RA患者病情更为复杂。Objective To analyze the correlation between ACPAs antibodies(mainly AMCV and ACCP)and osteoporosis secondary to rheumatoid arthritis,as well as bone mineral density and bone metabolism indicators.Methods According to the inclusion criteria and exclusion criteria,591 RA patients from the First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology were selected.The clinical data of the patients were recorded in detail.ELISA method was used to detect AMCV,ACCP,three subtypes of RF,and bone metabolism indicators PINP,β-CTX,N-MID OC,and 25HVD.DXA was used to detect BMD,BMC,Z value,and T value of the hip and lumbar spine of RA patients.Statistical analysis was performed with a SPSS 20 software.Results The AMCV and ACCP positive group had higher levels of IgA,IgM,three subtypes of RF than the negative group,but 25HVD was reversed.PINP and N-MID OC were positively correlated with the course of the disease,but bone mineral density indexes were negatively correlated with the course of the disease.25HVD was negatively correlated with ACCP,AMCV,and the three subtypes of RF.The levels of PINP and N-MID OC increased with the increase of the disease course.The levels of 25HVD and bone mineral density index decreased with the increase of the disease course.Compared with those in the normal bone mass group and the osteopenic group,the patients in osteoporosis group were older,with longer disease course,and higher RF levels of the three subtypes.Conclusion ACPAs antibodies were negatively correlated with 25HVD in RA patients.Bone mineral density and bone metabolism in RA patients were negatively correlated with the course of the disease.RA patients with secondary osteoporosis have more complicated condition.

关 键 词：类风湿关节炎 抗突变瓜氨酸波形蛋白抗体 抗环瓜氨酸肽抗体 骨密度 骨代谢 

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