LEP/sLEP-R在女性类风湿关节炎中的变化及其与骨质疏松的关系研究

Study of the alteration of LEP/sLEP-R in rheumatoid arthritis in females and its relationship with osteoporosis

目的探讨女性类风湿关节炎(RA)患者外周血瘦素(LEP)和可溶性瘦素受体(sLEP-R)的变化及其与女性RA骨质疏松的相关性。方法采用ELISA法测定55例女性RA患者和53例正常女性外周血中LEP、sLEP-R水平,采用双能X线骨密度吸收仪测定骨密度(BMD)。结果 (1)和正常女性相比,女性RA患者LEP水平明显升高(P<0.0001),sLEP-R水平明显降低(P<0.0001)。(2)女性RA组中骨质疏松发生率为38.2%,明显高于正常女性组的11.3%(χ2=10.386,P=0.001);绝经后或绝经前女性RA患者BMD均明显低于绝经后或绝经前(Neck部位除外)正常女性(P<0.001～0.0001);绝经后女性RA患者BMD亦明显低于绝经前女性RA患者(P<0.05)。(3)LinearRegression分析显示:女性RA患者外周血LEP水平与C反应蛋白呈直线正相关(P=0.045),与前臂、股骨Ward区和腰椎1-4 BMD呈直线负相关(P<0.05～0.0001);外周血sLEP-R水平与股骨Ward区、大转子和腰椎1-4 BMD呈直线正相关(P<0.05～0.0001)。结论女性RA患者外周血LEP和sLEP-R水平的变化与RA患者的骨代谢状态的变化密切相关。

Objective To explore the alteration of peripheral blood level of leptin （LEP） and soluble leptin-receptor （sLEP-R） in females with rheumatoid arthritis （RA） and its relationship with osteoporosis. Methods The levels of peripheral LEP and sLEP-R in 55 RA females and 53 normal female controls were detected using ELISA. Bone mineral density （BMD） was measured using dual energy X-ray absorptiometry. Results 1） Compared with normal female controls, the level of LEP in IRA decreased, while the level of sLEP-R increased significantly （P 〈 0. 0001 ）. 2） The incidence of osteoporosis in female RA （38.2%） was significantly higher than that in normal female controls （ 11.3% ） （2 = 10. 386, P =0. 001 ）. BMD in postmenopausal females or premenopausal females with RA was significantly lower than that in premenopausal or premenopausal （except BMD of the femoral neck） normal female controls （P 〈0. 001-0. 0001 ）. BMD of postmenopausal women with RA was significantly lower than that of premenopausal with RA （ P 〈 0. 05 ）. 3 ） Linear regression analysis showed that the level of peripheral LEP was positively correlated with C reactive protein （P = 0. 045 ）, but was negatively correlated with BMD at the position of forearm,Ward＇s region, and L1-4 （P 〈 0.05-0.0001 ）. There was positive correlation between the level of sLEP-R and BMD at the position of Ward＇s region, the greater trochanter, and L1-4 （P 〈 0. 05-0. 0001 ）. Conclusion There were close correlations between the levels of LEP and sLEP-R in peripheral blood and bone metabolism in female RA patients.