氧化应激和骨代谢水平与类风湿关节炎合并低骨量的相互关系

Levels of oxidative stress and bone turnover markers in patients with rheumatoid arthritis complicated with low bone mineral density

目的探讨RA患者体内AOPP水平和骨代谢标志物的变化,明确其与RA患者低骨量间的关系。方法收集RA患者70例,50例正常人作为对照组,检测两组BMD、AOPP、SOD、β-CTX和t PINP水平。再根据BMD值将RA患者分组OP组、骨量正常组和骨量减少组,分析各检测指标与骨量减少的相关性。结果 RA组腰椎BMD值和T值均低于正常组(P<0.05)。RA组AOPP、β-CTX水平较正常组显著升高(P<0.05),SOD、t PINP水平较正常人显著降低(P<0.05)。在RA患者中OP组与骨量正常组和骨量减少组相比,病程长,DAS28评分高,AOPP、β-CTX水平也明显增高(P<0.05),但在年龄、激素的服用率及DMARD服用率的比较上,OP组与另两组相比无差异(P>0.05)。线性回归方程分析发现,β-CTX、t PINP、AOPP、DAS28、病程、SOD、糖皮质激素服用情况可能均与骨量减少的发生相关(P<0.10),进一步采用多因素Logistic Regression回归分析后发现,β-CTX、AOPP、DAS28、病程为RA患者合并骨量下降的危险因素。结论 RA患者与正常人比骨量下降明显,骨质疏松的发生率高,其中病程、疾病活动及体内的氧化应激水平与骨量减少的发生相关,在制定RA的治疗方案时,可监测患者体内氧化应激和骨代谢水平的改变,必要时加用抗氧化剂治疗。

Objective To evaluate the relationship of level of oxidative stress and bone turnover markers in patients with rheumatoid arthritis（ RA） complicated with lowbone mineral density（ BMD）.Me thods We included 70 cases of patients with RA as test group and 50 cases of healthy people as control,and the RA patients further divided into three groups according to the results of BMD.The levels of advanced oxidation protein products（ AOPP）,superoxide dismutase（ SOD）,β C-telopeptide of type collagen（ β-CTX） and total procollagenⅠN-terminal peptide（ t PINP） were compared among the these groups by the SPSS 13.0.Re sults The BMD and its corresponding T-value in RA patients were lower than those of control group（ P〈0.05）.Meanwhile,the levels of AOPP and β-CTX in RA group were higher than the control group（ P〈0.05）.In the other way,the levels of SOD and t PINP were lower in RA group（ P〈0.05）.The RA with OP had the highest level of DAS28,AOPP,β-CTX and the longest disease duration（ P〈0.05）.It is no statistical difference among these groups in the values of age and ratio of medication.Importantly,multiple regression analysis revealed that DAS28,disease duration,AOPP and β-CTX were determinant factors for the statistical association between lowBMD in RA.Conclusion Oxidative stress can cause the disorder of bone metabolism,mainly increasing the bone destruction and affecting the BMD of RA patients with lowBMD.Furthermore,the antioxidant therapy may have a certain effect of the disease of lowBMD.