托珠单抗对类风湿关节炎合并骨质疏松患者骨代谢的改善作用

The improvement effect of tocilizumab on bone metabolism in the patients with rheumatoid arthritis complicated with osteoporosis

目的探讨对类风湿关节炎合并骨质疏松患者实施托珠单抗治疗对其骨代谢水平的影响。方法回顾性分析我院2015年9月~2016年9月收集的类风湿关节炎合并骨质疏松患者47例的临床资料。治疗前与治疗后3个月,分别检测患者的骨代谢、骨形成、骨吸收情况,并进行腰、股BMD测量。结果治疗前与治疗后3个月,经骨代谢指标检测与比较,可得患者的铁蛋白水平显著下降(P<0.05);但血磷、血钙、PTH、维生素D水平无明显变化(P均>0.05);经骨吸收与骨形成标检测与比较,可得患者的各项指标均出现明显变化,各项指标检测水平均显著下降(P均<0.05);治疗前后分别对患者的腰、股BMD进行检测,可得与治疗前比较密度均显著增加(P均<0.05)。治疗后患者体内的炎性因子水平均出现明显的下降(P均<0.05)。47例患者均顺利完成整个疗程的治疗,治疗过程中均未出现严重不良反应。结论对类风湿关节炎合并骨质疏松患者实施托珠单抗治疗效果确切,可以改善患者的骨代谢和骨形成、骨吸收情况,减轻骨破坏程度。

Objective To investigate the effect of tocilizumab on the level of bone metabolism in the patients with rheumatoid arthritis complicated with osteoporosis. Methods The clinical data of 47 patients with rheumatoid arthritis combined with osteoporosis in our hospital from September 2015 to September 2016 were retrospectively analyzed. Before treatment and 3 months after treatment,the bone metabolism,bone formation,and bone resQrption were tested and lumbar and femoral BMD was measured. Results Before treatment and 3 months after treatment,by the determination and comparison of bone metabolism indices, the levels of ferritin were significantly decreased （P〈0.05）; but the levels of serum phosphorus, calcium, PTH ,vitamin D did not change significantly （P all 〉0.05）; according to the determination and comparison of bone resorption and bone formation, all indices were significantly changed in the patients, and the determination levels of all indices were significantly decreased （P all 〈0.05 ）; before and after treatment, the lumbar and femoral BMD were detected,and the density was significantly increased compared with that before treatment （Pall 〈0.05）. After treatment,the level of inflammatory factors in the patients were significantly decreased （P all 〈0.05）. 47 patients successfully completed the entire course of treatment. No serious adverse events were observed during the course of treatment. Conclusion The curative effect of tocilizumab in the patients with rheumatoid arthritis complicated with osteoporosis has an exact effect,which can improve the bone metabolism,bone formation,and bone resorption, and reduce the degree of bone destruction.