^(99)锝-亚甲基二膦酸盐联合激素对类风湿关节炎患者血脂的影响  

Effect of Technetium-99 Conjugated With Methylene Diphosphonate Combined With Glucocorticoid on Serum Lipid in Patients With Rheumatoid Arthritis

作　　者：黄鹤卿[1] 林常红[2] 刘源[1] HUANG Heqing;LIN Changhong;LIU Yuan(Department of Rheumatology and Immunology,The First Affiliated Hospital of Xiamen University,Xiamen Fujian 361000,China;Department of Cadre Healthcare and Special Diagnosis,The First Affiliated Hospital of Xiamen University,Xiamen Fujian 361000,China)

机构地区：[1]厦门大学附属第一医院风湿免疫科,福建厦门361000 [2]厦门大学附属第一医院干部保健特诊,福建厦门361000

出　　处：《中国卫生标准管理》2022年第15期122-128,共7页China Health Standard Management

基　　金：国家自然科学基金项目(81971496)。

摘　　要：目的分析^(99)锝-亚甲基二膦酸盐(technetium-99 conjugated with methylene diphosphonate,99Tc-MDP)联合糖皮质激素(glucocorticoid,GC)对类风湿关节炎(rheumatoid arthritis,RA)患者血脂水平的影响。方法对2020年9月—2021年5月89例RA患者的血脂、C反应蛋白(C-reactive protein,CRP)和血沉(erythrocyte sedimentation rates,ESR)进行测定,对照组为同期厦门大学附属第一医院体检中心的57例健康对照者(healthy controls,HC)。其中^(99)Tc-MDP组45例,99Tc-MDP联合GC组44例,在基线期和^(99)Tc-MDP治疗10 d后,对各RA组患者的血脂水平和炎症指标进行分析。结果与HC相比,RA患者血清载脂蛋白A-1(apoproteinA-1,Apo-A1)水平显著降低,Apo-B/Apo-A值显著升高,差异有统计学意义(P<0.05)。^(99)Tc-MDP治疗后,两治疗组炎症指标均明显改善,甘油三酯(triglycerides,TG)与Apo-A1均较治疗前升高,Apo-B/Apo-A比值较治疗前降低,差异有统计学意义(P<0.05)。在^(99)Tc-MDP联合GC组中,高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)较治疗前升高,而载脂蛋白B(apoproteinB,Apo-B)、动脉粥样硬化指数(atherogenicindex,AI)较治疗前降低,差异有统计学意义(P<0.05)。^(99)Tc-MDP联合GC组治疗后^(99)Tc-MDP组治疗后对血脂的改善更显著,差异有统计学意义(P<0.05)。结论RA存在不良的血脂异常,^(99)Tc-MDP治疗可以改善炎症反应,改善血脂水平。^(99)Tc-MDP联合GC对血脂水平改善有协同作用,这有可能降低RA心血管疾病的风险。Objective To analyze the effect of technetium-99 combined with methylene diphosphonate(^(99)Tc-MDP)combined with glucocorticoid(GC)on the levels of serum lipid in patients with rheumatoid arthritis (RA). Methods The serum lipid, C-reactive protein (CRP) and erythrocyte sedimentation rates (ESR) of 89 patients from September 2020 to May 2021 with RA were measured and the control group was 57 healthy controls (HC) in the physical examination center of The First Affiliated Hospital of Xiamen University in the same period. There were 45 cases in ^(99)Tc-MDP group and 44 cases in ^(99)Tc- MDP combined GC group. The serum lipid levels and inflammatory indexes of RA groups were analyzed at baseline and 10 days after ^(99)Tc-MDP treatment. Results Compared with HC, the level of serum apoprotein A-1 (Apo-A1) in patients with RA was significantly lower and Apo-B/Apo-A ratio increased significantly, the differences were statistically significant (P < 0.05). After 99Tc-MDP treatment, the inflammatory indexes of the two treatment groups were significantly improved, triglycerides (TG) and Apo-A1 were higher than before treatment, and Apo-B/Apo-A ratio was lower than before treatment, the differences were statistically significant (P < 0.05). In 99Tc-MDP combined with GC group, high-density lipoprotein cholesterol (HDL-C) was higher than that before treatment, while apoprotein B (Apo-B) and atherogenic index (AI) were lower than that before treatment, the differences were statistically significant (P < 0.05). The improvement of serum lipid in 99Tc-MDP combined GC group was more significant than that in 99Tc-MDP group, the differences were statistically significant (P < 0.05). Conclusion RA has adverse dyslipidemia, ^(99)Tc-MDP treatment could improve inflammatory response and serum lipid level. ^(99)Tc-MDP combined with GC has a synergistic effect on the improvement of serum lipid level, which may reduce the risk of cardiovascular disease in RA.

关 键 词：^(99)锝-亚甲基二膦酸盐 类风湿关节炎 甘油三酯 高密度脂蛋白胆固醇 载脂蛋白A-1 动脉粥样硬化指数 

分 类 号：R684[医药卫生—骨科学]