类风湿关节炎患者骨密度与骨代谢指标的临床意义

Clinical Significance of Bone Metabolism Markers and Bone Mineral Density of Rheumatoid Arthritis

目的探讨类风湿关节炎(rheumatoid arthritis,RA)患者骨代谢指标、骨密度(bone mineraldensity,BMD)、骨矿物质含量(bone mineral conten,BMC)的变化及临床意义。方法选择2011年3月至2012年7月安徽医科大学附属省立医院风湿免疫科RA患者(RA组)及健康者(对照组),采用双能X线骨密度仪检测各组受试者前臂BMD和BMC含量,检测2组骨钙素(bone gla protein,BGP)、I型胶原交联羧基末端肽(C-terminal telopeptides of type I collagen,CTX)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C reactive protein,CRP)、类风湿因子(rheumatoid factor,RF)和抗环瓜氨酸肽抗体(anti-cyclic citrullinated peptide antibody,抗-CCP)。摄双手X线正位片,进行X线分期,计算患者疾病活动指数(disease activity score 28,DAS28)。结果 RA组患者71例,对照组20例。RA组骨代谢指标CTX和BGP明显高于对照组,差异有统计学意义(均P<0.05)。RA组前臂BMD、BMC,均低于对照组的BMD和BMC,差异有统计学意义(均P<0.01)。直线相关分析示RA组CTX与BMD和BMC均呈负相关(r=-0.301,P=0.014;r=-0.296,P=0.015);与病程、RF呈正相关(r=0.382,P=0.001;r=0.263,P=0.029);多元线性回归分析显示前臂BMD与RF、年龄呈负相关(r=-7.544、r=-3.254,P均<0.01);前臂BMC与DAS28呈负相关(t=-4.440,P<0.01);相关分析显示BMD、BMC与X线分期均呈负相关(r=-0.289、r=-0.284,P均<0.01),CTX与X线分期成正相关(r=0.333,P=0.005)。结论 RA患者骨代谢呈高转换型骨丢失,骨代谢指标及骨密度、骨矿盐含量可以预测RA患者出现骨破坏;RF可能为RA患者骨破坏的危险因素。

Objective To investigate the change and clinical significance of bone metabolism markers, bone mineral density （BMD） and bone mineral content BMC ） in patients with rheumatoid arthritis （RA）. Methods RA patients （RA group） and normal control group） from March 2011 to July 2013 in Department of Rheumatology, Anhui Medical University Affiliated Provincial Hospital were selected to this study. The level of bone gla protein （ BGP）, C-terminal telopeptides of type I collagen （CTX） in serum were measured by ELISA. The BMD and BMC in the forearm were measured by dual energy X rayabsorptiometry （DEXA）. The level of erythrocyte sedimentation rate （ESR） in serum was measured by Wilcoxon. The level of C reactive protein （CRP） in serum was measured by immunoturbidimetric, the level of rheumatoid factor （RF） in serum was measured by the rate nephelometry method. The level of anti-cyclic citrullinated peptide （CCP） in serum was measured by ELISA. The correlations of indexes were analyzed by linear correlation analysis and multiple linear regression analysis. Results There were 71 patients in the RA group and 20 in the control group. The CTX and BGP in the RA group were significant higher comparing to healthy controls （P 〈 0.05 ）. The BMD and the BMC were significantly deceased in RA comparing to healthy controls （P 〈 0. 05 ）. The BMD in forearm was negatively correlated with DAS28 score, ESR and RF （r = - 0. 357, - 0. 390, - 0. 255, P.〈 0. 05）. The multiple linear regression analysis showed that the CTX was negatively correlated with the BMD, BMC in forearm （r = - 0. 301, P = 0. 014; r = - 0. 296, P =0. 015）. There was a significant negative correlation between BMC in forearm and DAS28 score, ESR （r = - 0. 344, - 0. 401, P 〈 0. 05 ）. And multiple linear regression analysis showed that the BMD in forearm with RF and age were negatively correlated; The BMC in forearm was negatively correlated with the DAS score（t = -4. 440, P 〈 0. 01 ）. The Spearman correlation analysis showed that the BMD, BMC were negatively correlated with the X-ray （r = - 0. 289, r = - 0. 284, P were 〈 0. 01 in all analysis）, the CTX of RA with X-ray were positively correlated （r =0. 333, P =0. 005）. Conclusions The pattern of bone metabolism of RA patients is high conversion type of bone loss. The bone metabolic markers and bone mineral density, bone mineral content can be predicted in patients with RA bone destruction. The bone mineral density and bone mineral loss may be closely related with disease activity; RF may be a risk factor for RA bone damage.