类风湿关节炎血清总免疫复合物诱导破骨细胞分化引起骨质疏松的因素分析  

Osteoclast differentiation induced by total immune complex in serum of patients with rheumatoid arthritis leads to osteoporosis and its factors analysis

作　　者：周二叶[1] 曾克勤[1] 武剑[1] 任田[1] 何觅春[1] Zhou Erye;Zeng Keqin;Wu Jian;Ren Tian;He Michun(Department of Rheumatology,the First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu Province,China)

机构地区：[1]苏州大学附属第一医院风湿免疫科,江苏省苏州市215006

出　　处：《中国组织工程研究》2024年第35期5606-5611,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金面上项目(81771782),项目负责人:武剑;苏州市民生科技项目(SYSD2020103),项目负责人:曾克勤。

摘　　要：背景:类风湿关节炎患者骨质疏松症的发生率明显增高,患者血清中存在的大量免疫复合物是否促进了骨质疏松症的发生与发展仍不明确。目的:探讨类风湿关节炎患者血清总免疫复合物与骨质疏松症的关系。方法:(1)临床试验:选择50名健康体检者(健康对照组)与50例初治型类风湿关节炎患者(类风湿关节炎组),回顾性分析两组患者的临床资料与实验室检查,比较两组血清总免疫复合物水平。将类风湿关节炎患者血清总免疫复合物与骨密度、骨转换标志物及其他临床指标进行相关性分析。(2)细胞实验:分离培养健康志愿者外周血单核细胞,分4组处理:类风湿关节炎组加入类风湿关节炎患者血清总免疫复合物悬液,正常对照组加入健康体检者血清总免疫复合物悬液,阳性对照组加入含巨噬细胞集落刺激因子与核因子κB受体活化因子配体的α-MEM培养基,阴性对照组加入α-MEM培养基。处理7 d后进行抗酒石酸酸性磷酸酶染色,观察破骨细胞形成情况。结果与结论:(1)临床试验:类风湿关节炎组患者血清总免疫复合物、血清碱性磷酸酶水平均明显高于健康体检者(P<0.01,P<0.05);Pearson相关分析结果显示,类风湿关节炎患者血清总免疫复合物与血沉(r=0.330,P=0.019)、血清碱性磷酸酶(r=0.545,P=0.001)、抗环瓜氨酸肽抗体(r=0.377,P=0.007)和Ⅰ型胶原C端肽(r=0.738,P=0.001)呈正相关关系,与腰椎骨密度(r=-0.595,P=0.001)呈负相关关系;二元Logistic回归分析结果显示,年龄[OR=1.086,95%CI(1.022,1.154),P=0.008]、抗环瓜氨酸肽抗体[OR=1.002,95%CI(0.999,1.005),P=0.035]、Ⅰ型胶原C端肽[OR=0.141,95%CI(0.015,8.900),P=0.008]和血清总免疫复合物[OR=2.895,95%CI(1.228,6.827),P=0.001]是类风湿关节炎患者骨量异常(骨量减少或骨质疏松)的影响因素;(2)细胞实验:阳性对照组、正常对照组、类风湿关节炎组可见抗酒石酸酸性磷酸酶染色阳性的破骨细�BACKGROUND:The incidence of osteoporosis significantly increases in the patients with rheumatoid arthritis,and it remains unclear whether the presence of a large number of immune complexes in serum promotes the onset and development of osteoporosis.OBJECTIVE:To investigate the correlation between serum immune complexes and osteoporosis in patients with rheumatoid arthritis.METHODS:(1)Clinical trial:Serum and clinical data of 50 healthy controls and 50 patients with untreated rheumatoid arthritis were collected and retrospectively analyzed.Total immune complex level in serum was compared between two groups.Correlation of serum total immune complexes with bone mineral density,bone turnover markers and other clinical indicators in patients with rheumatoid arthritis was analyzed.(2)Cell experiment:Peripheral blood mononuclear cells from healthy volunteers were isolated and cultured,and divided into four groups:rheumatoid arthritis group was added with total immune complex suspension from rheumatoid arthritis patients;normal control group was added with total immune complex suspension from healthy medical checkups;positive control group was added withα-MEM medium containing macrophage colony-stimulating factor and receptor activator of nuclear factor-kappa B ligand,and negative control group was added withα-MEM medium.Tartrate-resistant acid phosphatase staining was performed to observe the formation of osteoclasts after 7 days of treatment,RESULTS AND CONCLUSION:(1)Clinical trial:The total immune complex and serum alkaline phosphatase levels in patients with rheumatoid arthritis were significantly higher than those in health controls(P<0.01,P<0.05).Pearson correlation analysis showed that serum total immune complex level was positively correlated with erythrocyte sedimentation rate(r=0.330,P=0.019),serum alkaline phosphatase(r=0.545,P=0.001),anti-cyclic citrullinate peptide(r=0.377,P=0.007)and c-terminal telopeptide of type I collagen(r=0.738,P=0.001),and negatively correlated with lumbar bone mineral density(r=-0.

关 键 词：类风湿关节炎 免疫复合物 骨转换标志物 骨质疏松症 骨免疫学 

分 类 号：R459.9[医药卫生—治疗学] R392[医药卫生—临床医学] R580