同型半胱氨酸与系统性红斑狼疮继发性骨质疏松的相关性研究

The value of homocysteine in osteoporosis secondary to systemic lupus erythematosus

目的探讨血清同型半胱氨酸(Hcy)水平与系统性红斑狼疮(SLE)患者并发骨质疏松之间的相关性。方法选择2017年12月至2018年5月在浙江省绍兴市中心医院就诊的SLE患者105例,根据发生骨质疏松性骨折的风险分为低危组(69例)、中高危组(36例);抗骨质疏松治疗12个月后,比较两组治疗前后的骨密度、血清Hcy水平的差异。结果两组患者治疗后腰椎(L1~L4)、股骨颈骨密度均较治疗前升高,差异有统计学意义(P<0.05)。低危组患者治疗后腰椎T值升高,差异有统计学意义(P<0.05),股骨颈T值有升高趋势,但差异无统计学意义(P>0.05);中高危组患者治疗后,腰椎、股骨颈T值均升高,差异有统计学意义(P<0.05)。中高危组治疗前Hcy较低危组升高[(15.42±4.13)μmol/L比(13.52±3.12)μmol/L],差异有统计学意义(P<0.05);两组患者治疗后血清Hcy水平均下降[(12.14±3.17)μmol/L比(13.52±3.12)μmol/L、(13.73±3.22)μmol/L比(15.42±4.13)μmol/L],差异有统计学意义(P<0.05);血清Hcy水平与骨密度值、T值均呈负相关,差异有统计学意义(P<0.05);血清Hcy水平与骨折风险呈正相关,差异有统计学意义(P<0.05)。结论SLE患者血清中Hcy水平和骨质疏松呈负相关,抗骨质疏松治疗后血清Hcy水平下降,Hcy有望成为自身免疫系统疾病继发性骨质疏松的一个生物标记物。

Objective To investigate the relationship between serum homocysteine(Hcy)and osteoporosis in patients with systemic lupus erythematosus(SLE).Methods A total of 105 SLE patients were selected in Shaoxing Central Hospital from December 2017 to May 2018.According to the risk of osteoporotic fracture,they were divided into two groups:low-risk group(69 patients),middle-high-risk group(36 patients).After anti-osteoporosis treatment for 12 months,the relationship between bone mineral density(BMD),T value and serum Hcy level were analyzed.Results The level of BMD of both groups increased after treatment,and the difference was statistically significant(P<0.05).In low-risk group,the T value of lumbar spine increased significantly after treatment(P<0.05).the T value of neck of femur had an upward trend,but the difference was not statistically significant(P>0.05).In middle-high-risk group,the T values of lumbar vertebrae and femoral neck were significantly higher after treatment(P<0.05).There was significant difference in serum Hcy between middle-high-risk group and low-risk group before treatment:(15.42±4.13)μmol/L vs.(13.52±3.12)μmol/L,P<0.05.The level of serum Hcy in both groups decreased after treatment:(12.14±3.17)μmol/L vs.(13.52±3.12)μmol/L,(13.73±3.22)μmol/L vs.(15.42±4.13)μmol/L,and the differences were statistically significant(P<0.05).The serum Hcy level was negatively correlated with both bone mineral density and T value(P<0.05).Positive correlation was observed between serum Hcy level and fracture risk(P<0.05).Conclusions Serum Hcy is negatively correlated with osteoporosis in SLE patients and declines significantly after anti-osteoporosis treatment.Hcy is expected to be a promising biomarker for secondary osteoporosis in patients with autoimmune system diseases.