云克对类风湿关节炎患者骨代谢的影响

Effect of Yun Ke on bone metabolism of patients with rheumatoid arthritis

目的:评价云克(锝[99Tc]亚甲基二膦酸盐)治疗对类风湿关节炎(RA)患者骨代谢的影响。方法:RA患者108例,云克治疗组72例,非云克治疗组36例;对照组54例。云克治疗3个月,测定治疗前后腕、髋和腰椎骨密度(BMD),同时检测血清Ⅰ型胶原氨基末端肽(NTX)水平,统计分析治疗前后骨代谢指标的差异。结果:与对照组比较,RA组腕、髋和腰椎BMD均显著下降(P<0.001)。与治疗前比较,云克治疗组6个月时RA患者腕、髋和腰椎BMD均增加(P<0.01);与非云克治疗组比较,云克治疗组RA患者腕、髋和腰椎BMD均增加(P<0.01);与非云克治疗组比较,云克治疗组3个月时血清Ⅰ型胶原氨基末端肽(NTX)水平下降(P<0.001);6个月时血清NTX水平下降,差异无统计学意义(P>0.05)。结论:腕关节BMD低且在RA患者显著下降。云克治疗增加RA患者腕、髋和腰椎BMD,降低血清NTX水平,能够抑制类风湿关节炎导致的骨量丢失。

Objective To evaluate the effect of Yun Ke on bone metabolism of patients with rheumatoid arthritis（RA）. Methods A total of 108 RA patients were divided into Yun Ke group（n = 72）, non-Yun Ke group（n = 36）, and 54 controls. The bone mineral densities（BMDs） of the wrists, hips and lumbar spines were measured by dual-energy X-ray absorptiometry. Moreover, the expression of cross-linked N-telopeptides of type I collagen（NTX） in the serum was detected for statistically analyzing the difference between Yun Ke group and non-Yun Ke group. Results In RA group, the BMDs of wrist, hip and lumbar spine declined compared with that of control group（P〈0.001, respectively）. In Yun Ke group, the BMDs of wrist, hip and lumbar spine after 6 months all were improved with statistically significance（P〈0.01, respectively）; The differences also were statistically significant when compared with those in non-Yun Ke group（P〈0.01, respectively）. In Yun Ke group, NTX level in the serum declined after 3 months of the treatment. The difference was statistically significant when compared with that in non-Yun Ke group（P〈0.001）, but the difference disappeared 6 months later. Conclusions The BMD of wrist joints is low and declines in RA patients significantly. The treatment with Yun Ke improves the BMDs of the wrist, hip and lumbar spine and decreases the serum NTX. This study proposed that Yun Ke could inhibit the chronic loss of bone mass induced by RA.