男性强直性脊柱炎患者骨代谢变化及小剂量激素的作用研究

Research on changes of bone metabolism in male patients with ankylosing spondylitis and the effect of small dose of hormone

目的探讨男性强直性脊柱炎（AS）患者骨代谢变化及小剂量糖皮质激素治疗后对其影响。方法选取2014年6月。2016年3月于浙江省杭州市富阳区第一人民医院（以下简称“我院”）风湿科治疗的男性AS患者46例作为病例组，选择同期在我院体检的男性健康者20名作为健康对照组。采用酶联免疫吸附试验（ELISA）检测病例组与健康对照组血清骨保护素（OPG）、白介素（IL）-17、巨噬细胞集落刺激因子（M—CSF）水平并与进行比较。46例AS患者根据治疗方法不同分为糖皮质激素（GCs）组（24例）和非GCs组（22例），比较治疗前、治疗后血清骨代谢指标、骨密度（BMD）差异。结果病例组血清OPG水平低于健康对照组，血清M—CSF、IL-17水平高于健康对照组，差异有统计学意义（P〈0．05）。与治疗前比较，治疗6个月后GCs组血清OPG显著升高（P〈0．05），IL-17、M—CSF明显降低（P〈0．05）；非GCs组血清OPG显著升高（P〈0．05），IL-17、M—CSF无明显变化（P〉0．05）。治疗后两组AS患者BMD均较治疗前有不同程度降低，但差异无统计学意义（P〉0．05）。结论AS患者存在骨代谢异常，小剂量GC对AS患者骨代谢指标有影响．但对BMD影响不大。AS患者短期应用小剂量GC治疗是安全有益的。

Objective To explore the changes of bone metabolism in male patients with ankylosing spondylitis （AS） and the effect of treatments with low dose of glucocorticoid. Methods 46 cases of male patients with AS treated in Rheumatology Department, the First People＇s Hospital of Fuyang District in Hangzhou City of Zhejiang Province （＂our hospital＂ for short） from June 2014 to March 2016 were selected as unhealthy group. 20 cases of healthy male taken physical examination in our hospital were selected as the healthy control group. Enzyme linked immunosorbent assay （ELISA） was used to detect the serum bone protection element （0PG）, interleukin （IL）-17, macrophages sets colony stimulating factor （M-CSF） levels in the unhealthy group and the healthy control group. 46 cases of AS patients were divided into two groups according to different treating methods, which were GCs group （24 cases） and non-GCs group （22 cases）, and the serum levels of bone metabolism indexes and BMD before treatment and after treatment in the two groups were compared. Results The serum level of OPG in the unhealthy group was lower than that in the healthy control group, the level of M-CSF and IL-17 in serum were higher than those in the healthy control group, the differences were statistically significant （P 〈 0.05）. Compared with before treatment, after 6 months of treatment, the serum OPG was significantly elevated in the GCs group （P 〈 0.05）, IL-17 and M-CSF were significantly decreased （P 〈 0.05）; in the non-GCs group, the serum OPG was significantly elevated （P 〈 0.05）, IL-17 and M-CSF were not significantly changed （P 〉 0.05）. After treatment, BMD of the two groups were significantly lower than those of before treatment, but the differences were not statistically significant （P 〉 0.05）. Conclusion AS patients have abnormal bone metabolism, small dose of GCs have impacts on bone metabolism indicators of AS patients, but have little impact on BMD. Short-term application of small doses of GCs treatment for AS patients is safe and beneficial.