强直性脊柱炎患者骨密度及骨代谢标志物的变化

Study of the changes of bone mineral density and bone metabolic markers in patients with ankylosing spondylitis

目的观察强直性脊柱炎(AS)患者骨密度(BMD)及骨代谢标志物的变化。方法 AS组:2013年1月-2015年2月,52例,男40例、女12例,年龄(32.33±13.51)岁;健康对照组:50例,男38例、女12例,年龄(31.52±11.87)岁。检测双股骨颈、腰椎1-4BMD与T值;血清骨钙素(BGP)、I型原胶原氨基端前肽(PINP)、I型胶原C-末端肽(CTX);AS组检测C-反应蛋白(CRP)、血沉(ESR),计算病情活动指数(BASDAI)及功能指数(BASFI)。采用t检验与相关分析。结果 (1)AS组男、女性双股骨颈BMD(0.943±0.163,0.940±0.148)低于对照组(1.179±0.142,1.176±0.141);腰椎1-4BMD(1.057±0.179,1.069±0.187)低于对照组(1.199±0.121,1.202±0.166);(2)AS组双股骨颈、腰椎1-4骨质疏松及骨量减少分别是57.69%和61.53%;(3)AS组双股骨颈、腰椎1-4BMD与BASDAI呈负相关性(r=-0.426、-0.478)(P<0.05);(4)AS组男、女性BGP含量(13.47±4.36、13.85±3.75)低于对照组(21.57±3.18、20.77±4.19)(P<0.05),PINP含量(24.47±3.53、23.66±4.73)低于对照组(32.25±4.33、31.17±3.20)(P<0.05),CTX含量(0.80±0.13、0.74±0.17)高于对照组(0.37±0.10、0.37±0.13)(P<0.05);(5)AS组BGP与双股骨颈、腰椎1-4BMD呈正相关性(r=0.475、0.431)(P<0.05),CTX呈负相关性(r=-0.516、-0.466)(P<0.05)。结论 AS患者存在BMD降低,BGP、PINP含量减少,CTX增加,导致骨质疏松,应采取防治措施。

Objective To observe the changes of bone marrow density （BMD） and bone metabolic markers in the patients with ankylosing spondylitis （AS）. Methods Fifty-two patients with AS, who were treated from January 2013 to February 2015, were enrolled in AS group. Among them, 40 were males, and 12 were females. And the average age was 32.33 ± 13.51 years old. Fifty patients were involved in control group, including 38 males and 12 females. And the average age was 31.52 ± 11.87 years old. BMD and T-value of the lumbar vertebrae （L1-4） and the bilateral femoral neck in both groups were detected. Levels of bone Gla protein （BGP）, C-terminal telopeptide of type I collagen （CTX）, and type I procollagen amino terminal propeptide （PINP） were detected in all cases. Serum C-reactive protein （CRP） and erythrocyte sedimentation rate （ESR） of patients in AS group were detected. Bath ankylosing spondylitis disease active index （BASDAI） and Bath ankylosing spondylitis functional index （BASFI） of patients in AS group were assessed. All data were analyzed using T test and correlation analysis. Results BMD of the bilateral femoral neck in AS group （0. 943 ±0. 163 and 0. 940 ±0. 148, respectively） was lower than that in control group （ 1. 179 ±0. 142 and 1. 176 ± 0. 141, respectively）. BMD of L1-4 in AS group （1. 057 ± 0. 179 and 1. 069 ± 0. 187, respectively） was lower than that in control group （ 1. 199 ± 0. 121 and 1. 202 ± 0. 166, respectively）. The incidence of osteoporosis and osteopenia in AS group was 57.69% and 61.53% , respectively. BMD of the bilateral femoral neck and L1-4 was negatively correlated with BASDAI （ r = -0. 426, r = -0.478）. BGP in AS group （13.47 ± 4. 36 and 13.85 ± 3.75, respectively） was lower than that in control group （ 21.57 ± 3. 18 and 20. 77 ± 4. 19, respectively）. PINP in AS group （24.47 ± 3.53 and 23.66 ± 4.73, respectively） was lower than that in control group （32.25 ± 4.33 and 31. 17 ± 3.20, respectively）. CTX in AS group （0.80 ± 0.13 and 0.74 ±0.17, respectively） was higher than that in control group （0. 37 ± 0. 10and 0.37 ± 0. 13, respectively）. BGP in AS group was positivelycorrelated with BMD of the bilateral femoral neck and L1-4 （r = -0.475, r = -0. 431 ）. CTX in AS group was negatively correlated with BMD of the bilateral femoral neck and L1-4 （ r = - 0. 516, - 0. 466）. Conclusion AS patients have decreased BMD, BGP, and PINP, and increased CTX, resulting in osteoporosis. Therefore, prevention method should be applied.