肿瘤坏死因子-α抑制剂对未使用糖皮质激素类风湿关节炎患者骨代谢水平的影响

Effects of TNF-α inhibitors on bone metabolism in rheumatoid arthritis patients without glucocorticoid treatment

目的:探讨未使用糖皮质激素类风湿关节炎(RA)患者骨代谢变化及其影响因素,并研究肿瘤坏死因子-α(TNF-α)抑制剂(注射用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白,强克)的治疗作用。方法:选择在我院住院诊治的65例未使用糖皮质激素的RA患者,测定血清中Ⅰ型胶原C-末端肽(CTX)、Ⅰ型胶原氨基端前肽(PINP)与骨钙蛋白的含量,并与红细胞沉降率(ESR)、C-反应蛋白、类风湿因子(RF)等因素进行相关分析。对照组为我院57例健康体检人员。给予30例RA患者皮下注射强克25 mg,每周2次,3个月后再次测定骨代谢指标,分析治疗前后的变化。结果:(1)RA患者血清CTX含量(511.37±204.48) ng/L明显高于对照组[(391.62±143.68) ng/L,P <0.05],血清PINP含量(42.19±15.39)μg/L明显低于对照组[(49.61±15.42)μg/L,P <0.05]。(2)RA患者血清CTX含量与其年龄、DAS28评分、ESR、C反应蛋白呈明显正相关(r分别为0.483、0.367、0.410、0.361,P均<0.01),血清PINP、骨钙蛋白含量与病程呈正相关(r分别为0.272、0.303,P均<0.01)。(3)RA患者接受TNF-α抑制剂治疗后,血清PINP、骨钙蛋白含量均较治疗前明显升高[(80.79±63.88) vs (60.23±45.93)μg/L,P <0.05;(22.13±14.46) vs (16.74±8.46)μg/L,P <0.05]。结论:RA患者破骨增高、成骨降低;骨代谢水平主要与病程、疾病活动度相关;予以TNF-α抑制剂治疗后骨代谢水平有所改善。

Objective: To investigate the changes of bone metabolism in patients without glucocorticoid rheumatoid arthritis ( RA) and their influencing factors,and to investigate the therapeutic effect of tumor necrosis factor-α( TNF-α) inhibitor ( Qiangke). Methods: Sixty-five patients hospitalized in our hospital diagnosis and treatment of unused glucocorticoid RA patients were collected,serum type Ⅰ collagen C-terminal peptide ( CTX),type Ⅰ collagen amino terminal propeptide ( PINP) and osteocalcin levels were determined,and erythrocyte sedimentation rate ( ESR),C-reactive protein,rheumatoid factor ( RF) and other factors for correlation analysis. The control group was 57 healthy medical examiners in our hospital. A total of 30 RA patients were given subcutaneous injection of 25 g twice a week,and bone metabolism indicators were measured again after 3 months to understand the changes before and after treatment. Results:① The serum CTX level ( 511. 37 ± 204. 48) ng /L in RA patients was significantly higher than that in the control group [( 391. 62 ± 143. 68) ng /L,P < 0. 05],and the serum PINP level ( 42. 19 ± 15. 39)μg /L was significantly lower than the control group [( 49. 61 ± 15. 42)μg /L,P < 0. 05].② Serum CTX levels in RA patients were positively correlated with age,DAS28 score,ESR,Creactive protein ( r were 0. 483,0. 367,0. 410,0. 361 respectively,all P < 0. 01),and serum PINP and osteocalcin levels were positively correlated with disease duration ( r were 0. 272,0. 303 respectively,all P < 0. 01).③ Serum PINP and osteocalcin levels were significantly higher in RA patients after treatment with Qiangke [( 80. 79 ± 63. 88)μg /L vs ( 60. 23 ± 45. 93)μg /L,P < 0. 05;( 22. 13 ± 14. 46)μg /L vs ( 16. 74 ± 8. 46)μg /L,P < 0. 05]. Conclusion: RA patients showed increased osteoclast and decreased osteogenesis. The level of bone metabolism was related to the course of disease and disease activity. Bone metabolism was improved after TNF-α inhibitor treatment.