综合疗法对强直性脊柱炎伴骨质疏松患者血清富含半胱氨酸的酸性蛋白酶的影响

Effects of Comprehensive Therapy on Serum SPARC Levels in Ankylosing Spondylitis Patients Accompanied with Osteoporosis

目的观察综合疗法对强直性脊柱炎(ankylosing spondylitis,AS)伴骨质疏松患者血清富含半胱氨酸的酸性蛋白酶(serum secreted protein acidic and rich in cysteine,SPARC)水平的影响,探讨SPARC在AS伴骨质疏松发生过程中可能的作用机制。方法 48例AS伴骨质疏松患者(AS组)采用推拿、静脉滴注鹿瓜多肽注射液及口服补肾祛寒治尪汤治疗3个月,并以健康人45名为健康对照组(对照组);采用酶联免疫吸附法测定AS组治疗前后及对照组的血清SPARC水平,股骨颈骨密度(bone mineral density of femoral neck,FN BMD)、腰2-腰4骨密度(bone mineral density of 2-4 lumbar spine,L2-4BMD)、骨碱性磷酸酶(bone specific alkaline phosphatase,BSAP)、肿瘤坏死因子α(TNF-α)、转化生长因子β1(TGF-β1)水平。同时检测AS组治疗前后Bath AS疾病活动指数(Bath AS disease activity index,BASDAI)及Bath AS功能指数(Bath AS functional index,BASFI),并分析上述指标与血清SPARC水平间的相互关系。结果 AS组血清SPARC水平明显低于对照组(μg/L,175.30±72.04vs190.52±86.13,P<0.01)。AS组血清SPARC水平与TNF-α呈负相关(r=-0.261,P<0.01),与L2-4BMD、TGF-β1、BSAP呈正相关(r=0.437,0.256,0.385,P<0.05,P<0.01);L2-4BMD和BSAP是影响AS组血清SPARC水平的独立相关因素。AS组经综合治疗后TNF-α、BAS-DAI、BASFI明显降低,TGF-β1、BSAP、L2-4BMD和FNBMD明显升高(P<0.05,P<0.01),血清SPARC水平也显著升高[(188.32±87.50)μg/L,P<0.05]。结论综合疗法能有效改善AS伴骨质疏松患者骨代谢水平、临床症状和关节活动功能,同时升高其血清SPARC水平。

Objective To observe the effects of comprehensive therapy on serum secreted protein acidic and rich in cysteine （SPARC） levels in ankylosing spondylitis （AS） patients accompanied with osteoporosis （OP）, and to explore the possible mechanisms for SPARC in AS patients accompanied with osteoporosis. Methods Totally 48 AS patients accompanied with OP （Group A） were treated with massage, intravenous infusion of Cervus and Cucumis Polypeptide Injection, and Bushen Quhan Zhiwang Decoction （BQZD） for 3 months. At the same time, 45 normal healthy subjects were recruited as the normal control group （Group B）. Serum SPARC levels were measured by ELISA in Group A before and after comprehensive therapy and in those of Group B. The levels of bone mineral density of femoral neck （FN BMD）, bone mineral density of 2-4 lumbar spine （L 2-4 BMD）, bone specific alkaline phosphatase （BSAP）, tumor necrosis factor alpha （TNF-α）, and transforming growth factor β-1 （TGF-β 1） were detected. Meanwhile, Bath AS disease activity index （BASDAI） and Bath AS functional index （BASFI） were detected in Group A before and after treatment. The correlations between the aforesaid indices and serum SPARC levels were analyzed. Results Serum SPARC levels were significantly lower in those of Group A than in those of Group B （175.30±72.04 μg/L vs 190.52 ±86.13 μg/ L, P0.01）. Serum SPARC levels in those of Group A were negatively correlated with TNF-α （r=-0.261, P0.01）, positively with L 2-4 BMD, TGF-β 1, and BSAP （r=0.437, 0.256, 0.385, P0.05, P0.01）. L 2-4 BMD and BSAP were independently predictors of serum SPARC in patients of Group A. After comprehensive therapy, the levels of TNF-α, BASDAI, and BASFI obviously decreased, TGF-β 1, BSAP, L 2-4 BMD, and FN BMD obviously increased （P0.05, P0.01）. The serum SPARC levels also significantly increased （188.32±87.50 μg/L, P0.05）. Conclusion Comprehensive therapy could effectively improve the bone metabolism, clinical symptoms and the activity function of joints, and elevate serum SPARC levels.