老年类风湿性关节炎患者血清TNF-α、IL-34水平表达与继发骨质疏松的关系及预测模型的构建  

Relationship Between Serum TNF-α and IL-34 Levels and Secondary Osteoporosis in Elderly Patients with Rheumatoid Arthritis and Construction of Prediction Model

作　　者：张帅虎 刘创 ZHANG Shuaihu;LIU Chuang(Hand and Foot Microsurgery,the Second People’s Hospital of Henan Province,Zhengzhou 450000,China)

机构地区：[1]河南省第二人民医院手足显微外科,河南郑州450000

出　　处：《河南医学研究》2024年第23期4314-4318,共5页Henan Medical Research

摘　　要：目的研究老年类风湿性关节炎(RA)患者血清肿瘤坏死因子-α(TNF-α)、白介素-34(IL-34)水平表达与继发骨质疏松的关系及预测模型的构建。方法选取2020年1月至2023年1月河南省第二人民医院收治的122例老年RA患者为研究对象(研究组),同时期招募100例健康志愿者作为对照组。对所有受试者进行骨密度和血清TNF-α、IL-34水平检测,比较研究组和对照组骨密度和血清TNF-α、IL-34水平。根据骨密度降低程度将研究组患者分为骨质疏松继发组和未继发组。采用logistic回归分析RA患者继发骨质疏松的危险因素,并基于血清TNF-α、IL-34水平构建RA患者继发骨质疏松的预测模型。采用受试者工作特征(ROC)曲线和Hosmer-Lemeshow法评估预测模型的预测效能和模型拟合度。结果研究组患者血清TNF-α、IL-34水平高于对照组(P<0.05),腰椎与髋骨骨密度水平低于对照组(P<0.05)。继发组服用抗风湿性药物、关节功能分级(Ⅱ级及其以上)占比、病程、红细胞沉降率(ESR)水平高于未继发组(P<0.05),每周固定锻炼占比低于未继发组(P<0.05)。继发组患者血清TNF-α、IL-34水平高于未继发组(P<0.05),腰椎与髋骨骨密度水平低于未继发组(P<0.05)。logistic回归分析显示TNF-α、IL-34、病程、ESR、服用抗风湿性药物、关节功能分级(Ⅱ级及其以上)均是影响RA患者继发骨质疏松的独立危险因素(P<0.05),每周固定锻炼是RA患者继发骨质疏松的保护因素(P<0.05)。根据logistic结果建立RA患者继发骨质疏松指数方程,Hosmer-Lemeshow拟合优度检验结果显示,该模型具有较高的拟合优度(χ2=4.326,P=0.389)。构建的预测模型预测RA患者继发骨质疏松的ROC曲线下面积(AUC)、灵敏度、特异度分别为0.839(95%CI:0.716~0.943)、94.20%、72.80%。结论TNF-α、IL-34、病程、服用抗风湿性药物、关节功能分级(Ⅱ级及其以上)、ESR是影响RA患者继发骨质疏松的独立危险因素,�Objective To study the relationship between serum tumor necrosis factor-α(TNF-α)and interleukin-34(IL-34)levels and secondary osteoporosis in elderly patients with rheumatoid arthritis(RA)and establish a predictive model.Methods A total of 122 elderly RA patients admitted to the Second People’s Hospital of Henan Province from January 2020 to January 2023 were selected as the study group,and 100 healthy volunteers were recruited as the control group during the same period.Bone minering density and serum TNF-αand IL-34 levels were measured in all subjects,and bone minering density and serum TNF-αand IL-34 levels were compared between the study group and the control group.The study group was divided into secondary osteoporosis group and non-secondary osteoporosis group according to the degree of bone mineral density reduction.Logistic regression was used to analyze the risk factors of secondary osteoporosis in RA patients,and the prediction model of secondary osteoporosis in RA patients was constructed based on serum levels of TNF-αand IL-34.Receiver operating characteristic(ROC)curve and Hosmer-Lemeshow method were used to evaluate the prediction efficiency and model fit.Results The levels of serum TNF-αand IL-34 in the study group were higher than those in the control group(P<0.05),and the bone minering density levels of lumbar spine and hip bone were lower than those in the control group(P<0.05).The proportion of taking antirheumatic drugs,joint function grade(Ⅱand above),disease course and erythrocyte sedimentation rate(ESR)in secondary group were higher than those in non-secondary group(P<0.05),and the proportion of weekly fixed exercise was lower than that in non-secondary group(P<0.05).The levels of serum TNF-αand IL-34 in secondary group were higher than those in non-secondary group(P<0.05),and the bone minering density levels in lumbar spine and hip bone were lower than those in non-secondary group(P<0.05).Logistic regression analysis showed that TNF-α,IL-34,course of disease,ESR,taking anti-rhe

关 键 词：类风湿性关节炎 老年 骨质疏松 肿瘤坏死因子-Α 白介素-34 

分 类 号：R593.22[医药卫生—内科学]