类风湿性关节炎继发骨质疏松患者血清指标与骨代谢的关系  

Relationship between serum indices and bone metabolism in rheumatoid arthritis patients with secondary osteoporosis

作　　者：任占芬[1] 杨金良[1] 罗寰[1] 闫静[1] 左路广 赵悦 王建芳 Ren Zhanfen;Yang Jinliang;Luo Huan;Yan Jing;Zuo Luguang;Zhao Yue;Wang Jianfang(Department of Rheumatology and Immunology,The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Clinical Laboratory,The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院风湿免疫科,张家口075000 [2]河北北方学院附属第一医院检验科,张家口075000

出　　处：《中华关节外科杂志（电子版）》2022年第4期399-405,共7页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：河北省卫健委青年科技基金项目(20200512)。

摘　　要：目的:探究类风湿性关节炎(RA)继发骨质疏松症(OP)患者的类风湿因子(RF)、白介素(IL)-34、核因子κB受体活化因子配体(RANKL)、高密度脂蛋白胆固醇(HDL-C)水平与骨密度(BMD)和骨代谢的相关性研究。方法:选择2019年7月至2020年7月于河北北方学院附属第一医院接受检查且近期未接受激素治疗的RA患者120例,排除其他风湿免疫性疾病者。分别选取入组患者左侧股骨颈、左侧髋部、腰椎(L1-4)进行BMD测量,根据BMD含量分为骨量正常35例、骨量减少组56例、OP组29例,采用方差分析和LSD-t检验比较三组患者的红细胞沉降率(ESR)、抗环瓜氨酸肽抗体、RF、C-反应蛋白(CRP)、IL-34、RANKL、HDL-C、骨代谢指标[血清骨钙素(BGP)、Ⅰ型胶原交联羧基末端肽(CTX-Ⅰ)、骨特异性碱性磷酸酶(BALP)]等理化指标水平及类风湿性关节炎疾病活动评价(DAS-28评分)的差异,采用卡方检验比较各组患者糖皮质激素用药情况,采用Pearson相关性分析分析各指标与BMD和骨代谢之间的关系。结果:三组间左侧股骨颈、左侧髋部及腰椎(L1-4)BMD水平比较差异有统计学意义,OP组明显低于骨量减少组和骨量正常组(F=60.326、51.120、65.876,均为P<0.05);三组间ESR、抗环瓜氨酸肽抗体、CRP、IL-34、RANKL、HDL-C、CTX-Ⅰ、RF、BALP、BGP组间比较差异有统计学意义(F=237.285、11.457、3.437、35.967、16.099、12.709、138.588、14.022、100.737,均为P<0.05)。其中OP组患者的ESR、抗环瓜氨酸肽抗体、CRP、IL-34、RANKL、CTX-Ⅰ、RF、BALP明显高于骨量正常组和骨量减少组(均为P<0.05),而HDL-C、BGP明显低于骨量正常组和骨量减少组(均为P<0.05)。Pearson相关分析结果显示,左股骨颈(r=0.478、0.258、0.288、0.434、0.257、0.254、0.311、0.413、0.404)、左髋部(r=0.523、0.384、0.294、0.422、0.261、0.273、0.342、0.387、0.358)、腰椎(L1-4)(r=0.335、0.297、0.305、0.318、0.264、0.266、0.314、0.364、0.309)的BMD水平Objective To explore the correlations of bone mineral density(BMD)and bone metabolism with rheumatoid factor(RF),interleukin(IL)-34,receptor activator for nuclear factor-kB ligand(RANKL),high density lipoprotein cholesterol(HDL-C)levels in the patients of osteoporosis(OP)secondary o rheumatoid arthritis(RA).Methods A total of 120 RA patients who accepted examinations without hormone therapy treatment recently in the First Affiliated Hospital of Hebei North University from July 2019 to July 2020 were enrolled,while the patients with other rheumatic immune diseases were excluded.The BMD levels of left femoral neck,left hip,and lumbar spine(LI-4)were examined.According to the BMD data,the patients were divided into the normal bone mass group(35 cases),the bone loss group(56 cases)and the OP group(29 cases);the erythrocyte sedimentation rate(ESR),anti-cyclic citrullin peptide antibody,RF,C-reactive protein(CRP),IL-34,RANKL,HDL-C,bone metabolism indices[serum osteocalcin(BGP),type I collagen cross-linked carboxyl terminal peptide(CTX-I.),bone-specific alkaline phosphatase(BALP)]were compared among the three groups.The differences in isophystochemical indexes mentioned above and the DAS-28 score were compared and analyzed.Chi-square test was used to compare the glucocorticoid medication of various groups,and the relationships between BMD and the serum indices of inflammation and bone metabolism were analyzed by Pearson correlation analysis.Results The differences in BMD levels of the left femoral neck,left hip and lumbar vertebrae(LI 4)were statistically significantly among the three groups,and the BMD levels in the OP group were lower than the osteopenia group and the normal bone mass group(F=60.326,51.120,65.876,all P<0.05);There were statistically significant differences in ESR,anticyclocloclosine peptide antibody,CRP,IL-34,RANKL,HDL-C,CTX-I,RF,BALP,and BGP among the three groups(F=237.285,11.457,3.437,35.967,16.099,12.709,138.588,14.022,100.737,all P<0.05).The ESR,anti-cyclic citrullin peptide antibody,CRP,IL-34,RA

关 键 词：关节炎 类风湿 骨质疏松 类风湿因子 

分 类 号：R687.4[医药卫生—骨科学]