强直性脊柱炎156例骨丢失特点及相关因素分析

Analysis on the features and relevant factors of bone loss with 156 patients in Ankylosing Spondylitis

目的 探讨强直性脊柱炎（AS）患者的骨丢失特点及相关因素.方法 收集156例AS确诊患者,测定患者Bath指数、血沉（ESR）、C反应蛋白（CRP）、骨密度、血清骨源性碱性磷酸酶（BAP）、抗酒石酸酸性磷酸酶5b（TRAP5b）及1,25-（HO）2VitD3浓度,分析骨代谢指标变化特点及与临床指标相关性.结果 AS患者的血清TRAP5b较正常组增高（P＜0.05）,1,25-（HO）2VitD3浓度和BAP水平与正常组的差异均无统计学意义（均P ＞0.05）.骨密度测定显示：骨质疏松、骨量减少和骨量正常者分别为49、51、56例,骨质疏松组ESR、CRP、TRAP5b均高于骨量减少和骨量正常组（P＜0.05或0.01）;骨质疏松组的Bath疾病活动指数（BASDAI）、BAP均较正常组增高 （均P＜0.05）,Bath功能指数（BASFI）较骨量减少组增高（P＜0.05）.TRAP5b与CRP、BASFI、BASDAI呈正相关（均P＜0.05）. 结论 AS患者普遍存在骨代谢异常,表现为高转换骨丢失,并与CRP、BASDAI、BASFI呈正相关,提示骨丢失是AS病情活动的临床表现之一.

Objective Investigate the features and relevant factors of bone loss in ankylosing spondylitis （AS）. Methods The bone metabolism biochemical indices including bone alkaline phosphatase （BAP）, serum tartrate-resistant acid phosphatase 5b （TRAP5b） and 1,25-（HO）2VitD3 were tested in 156 patients with AS. In addition, Erythrocyte Sedimentation Rate （ESR）, C-reactive protein （CRP）, the Bath index （BASFI, BASDAI, BASMI） and Bone mineral density （BMD） were evaluated in air patients as clinical indices. The correlation between the bone metabolism biochemical indices and clinical indices were analyzed. Results The TRAP5b and BAP level were increased in all 156 patients with AS. There were significant differences in TRAP5b between patients with AS and normal control group （P 〈0.05）, however, no significant differences in 1,25- （HO）2VitD3 were observed （P 〉0.05）. 15patients could be devided into 3 groups according to the BMD level, 49 patients in osteoporosis group, 51 patients in bone loss group and normal BMD groups with 56 patients. The ESR, CRP and TRAP5b in osteoporosis group were significantly higher than in other two groups （P 〈0.05）. The BASDAI and BAP in osteoporosis group were significantly higher than in normal BMD group （P 〈0.05）. There was significant increases in BASFI level in patients with osteoporosis compared to those with normal BMD （P 〈0.05）. TRAP5b as a bone metabolism biochemical index had significantly positive correlation with CRP, BASFI and BASDAI （P 〈0.05）.Conclusions High-bone-turnover bone loss, as a sign of the abnormal bone metabolism was commonly found in patients with AS. The bone loss had significantly positive correlation with CRP, BASDAI and BASFI, which indicated that could reflect the disease activity of AS.