类风湿关节炎患者合并骨质疏松的临床研究

Clinical Study on Osteoporosis in Rheumatoid Arthritis Patients

目的探讨类风湿关节炎(rheumatiod arthritis,RA)患者合并骨质疏松症(osteoporosis,OP)的情况及其骨代谢水平。方法采用双能X线吸收法测定RA患者腰椎前后位(L2～L4)、双侧股骨颈、大转子的骨密度;采用酶联免疫吸附法测定外周血骨保护素(osteoprotegerin,OPG)、骨钙素(bone gal protein,BGP)等骨代谢参数以及炎性因子白介素(interleukin,IL)-1β的水平,并同时对临床指标进行分析。结果 RA患者OP的发生率为56.67%,女性高于男性,绝经后高于绝经前,OP的发生率在大转子处最高。与正常对照比,RA患者血清OPG水平显著降低,IL-1β、BGP水平显著升高;合并OP的RA患者较骨量正常或骨量减少的RA患者年龄大,血清钙水平低,OPG、IL-1β和碱性磷酸酶水平高。结论 RA患者存在较高的OP发生率,老年及绝经后女性尤为明显,OP的发生与较高的骨转换率有关。

Objective To investigate the incidence of osteoporosis （OP） and bone metabolic level in rheumatoid arthritis （RA） patients. Methods Bone mineral density of RA inpatients were measured by dual-energy X ray absorptiometry, including lumbar （L2-IA）, bilateral femoral neck and greater trochanter. The proinflammatory cytokine interleukin-1 and bone metabolic markers bone gla protein （BGP） and osteoprotegerin （OPG） were measured by enzyme linked immunosorbent assay. Some clinical data were collected at the same time. Results The incidence of OP in RA patients was 56. 67%. The incidence of OP in female RA patients was higher than that in the male and so was in the postmenopausal than in the premenopausal women. The site with highest incidence of OP was greater trochanter. Compared with normal controls, the serum levels of IL-113 and BGP in RA patients was significantly higher, and the levels of OPG was significantly lower. Patients in the OP group were older in age, had lower level of serum Ca but higher levels of serum OPG, IL-113 and ALP compared with osteopenia and normal BMD group. Conclusions The incidence of OP in RA patients is high, which is more evident in elderly and post-menopausal women. The occurrence of OP in RA is related with hizh bone turn-over rate.