血清镍纹蛋白样蛋白和可溶性核因子-κB受体活化因子配体对类风湿关节炎合并骨质疏松症的诊断价值  

Expression and diagnostic value of serum Metrnl and sRANKL in patients with rheumatoid arthritis com-bined with osteoporosis

作　　者：王春雨 吴小芬 杜军 徐进 赵金英 WANG Chunyu;WU Xiaofen;DU Jun;XU Jin;ZHAO Jinying(Department of Endocrinology,the 940th Hospital of the Joint Logistics Support Force,PLA,Lanzhou 730050,Gan-su,China)

机构地区：[1]解放军联勤保障部队第九四〇医院内分泌科,兰州730050

出　　处：《医学研究与战创伤救治》2025年第3期263-267,共5页Journal of Medical Research & Combat Trauma Care

基　　金：甘肃省自然科学基金(24JRRA008)。

摘　　要：目的探索血清镍纹蛋白样蛋白(Metrnl)和可溶性核因子-κB受体活化因子配体(sRANKL)在类风湿关节炎(RA)合并骨质疏松症(OP)患者中的表达及诊断价值。方法回顾性分析2021年10月-2023年10月解放军联勤保障部队第九四〇医院收治的120例RA合并OP患者(RA+OP组)的临床资料,选择同期116例RA患者(RA组)作为对照。采用酶联免疫吸附法(ELISA)检测血清Metrnl、sRANKL水平;收集患者临床资料,对RA合并OP的影响因素进行单因素及多因素分析;受试者工作特征(ROC)曲线分析血清Metrnl、sRANKL检测对RA合并OP的诊断价值。结果RA+OP组患者血清Metrnl、sRANKL水平高于RA组(t=9.185,8.561,P<0.01),RA+OP组患者年龄、病程、骨折史人数、红细胞沉降率(ESR)、RA患者病情评价(DAS28评分)、RA影像评分(Sharp评分)高于RA组患者,补充钙剂人数少于RA组患者(P<0.05);多因素logistic回归分析显示年龄(OR=2.035,95%CI=1.232~3.361)、补充钙剂(OR=0.508,95%CI=0.289~0.892)、DAS28评分(OR=2.143,95%CI=1.136~4.044)、Sharp评分(OR=2.113,95%CI=1.102~4.050)及血清Metrnl(OR=2.547,95%CI=1.305~4.969)、sRANKL(OR=2.687,95%CI=1.385~5.212)水平是RA合并OP的影响因素(P<0.05);Metrnl与s RANKL联合诊断RA合并OP的ROC曲线下面积(AUC)显著大于Metrnl单独诊断的AUC(Z=3.794,P<0.001)和s RANKL单独诊断的AUC(Z=3.787,P<0.001)。结论RA合并OP患者血清Metrnl、sRANKL水平升高,是RA合并OP的影响因素,联合检测能够为RA合并OP的临床诊断提供参考。Objective Exploring the expression and diagnostic value of serum meteorin-like(Metrnl)and soluble receptor activator of nuclear factor-κB ligand(sRANKL)in patients with rheumatoid arthritis(RA)combined with osteoporosis(OP).Methods A retrospective analysis was conducted on the clinical data of 120 patients with RA combined with OP(RA+OP group)ad-mitted to the 940th Hospital of the Joint Logistics Support Force from October 2021 to October 2023.During the same period,116 pa-tients with RA(RA group)were selected as controls.The levels of serum Metrnl and sRANKL was detected by enzyme linked immu-nosorbent assay(ELISA).Clinical data of the patients were collected,and univariate and multivariate analyses were performed to identify the influencing factors of RA combined with OP.Receiver op-erating characteristic(ROC)curve analysis was applied to evaluate the diagnostic value of serum Metrnl and sRANKL in RA combined with OP.Results The levels of serum Metrnl and sRANKL in the RA+OP group were higher than those in the RA group(t=9.185,8.561,P<0.01).Patients in the RA+OP group were older,had a longer disease duration,more fracture history,higher erythrocyte sedimentation rate(ESR),higher Disease Activity Score in 28 joints(DAS28),and higher Sharp score compared to the RA group.Additionally,fewer patients in the RA+OP group were taking calcium supplements than in the RA group(P<0.05).Multivariate Logistic regression analysis showed that age(OR=2.035,95%CI=1.232-3.361),calcium supplementation(OR=0.508,95%CI=0.289-0.892),DAS28 score(OR=2.143,95%CI=1.136-4.044),Sharp score(OR=2.113,95%CI=1.102-4.050),as well as serum Metrnl(OR=2.547,95%CI=1.305-4.969)and sRANKL(OR=2.687,95%CI=1.385-5.212)levels were influencing factors for RA combined with OP(P<0.05).The area under the ROC curve(AUC)of the combined diagnosis of RA+OP using Metrnl and sRANKL was signigicantly greater than that for Metrnl alone(Z=3.794,P<0.001)and sRANKL alone(Z=3.787,P<0.001).Conclusion The levels of serum Metrnl and sRANKL are elevated in patients with RA

关 键 词：镍纹蛋白样蛋白 可溶性核因子-κB受体活化因子配体 类风湿关节炎 骨质疏松症 诊断价值 

分 类 号：R684.3[医药卫生—骨科学]