青壮年强直性脊柱炎骨代谢类型对临床预防及治疗意义的研究

Study on the clinical significance of bone metabolism types in young adult patients with ankylosing spondylitis

目的探讨青壮年活动期强直性脊柱炎(AS)骨代谢类型与骨密度之间的关系,为临床青壮年AS骨密度下降者的预防及治疗提供依据。方法纳入2015年2月—2020年11月在浙江省人民医院就诊的AS患者103例,分析不同骨代谢类型与骨密度的相关性。结果入组的103例AS患者,骨密度正常组49例,骨密度低下组54例。骨密度低下组患者Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、N端骨钙素(OC)、总Ⅰ型胶原氨基端前肽(P1NP)的均值均显著高于骨密度正常组(均P<0.001)。骨密度低下组又分为低中转换组(28例)和高转换组(26例)。高转换组的股骨颈骨密度T值为-1.56±0.82,显著性低于中低转换组(-1.01±0.92,P=0.029)。2组腰椎的骨密度T值比较差异无统计学意义(P=0.080)。对于不同骨代谢类型治疗前后比较发现:在中低转换组,治疗后股骨颈骨密度值[(0.92±0.09)g/cm^(2)]较治疗前[(0.89±0.08)g/cm^(2)]显著改善(P=0.022);而在高转换组,治疗后股骨颈骨密度值较治疗前差异无统计学意义(P=0.080)。结论青壮年AS骨密度下降患者血清β-CTX、OC、P1NP明显升高,表现为高转换骨丢失;中低转换的骨密度下降患者通过积极基础病炎症控制,骨密度可以得到有效提升;但是,高转换骨密度下降患者治疗后骨量无显著提升,应探索更为有效的治疗方案。

Objective To investigate the relationship between bone metabolism and bone mineral density in young adults with active ankylosing spondylitis(AS)and to provide a basis for the prevention and treatment of bone mineral density decline in these patients.Methods A total of 103 patients with AS who were treated in our hospital from February 2015 to November 2020 were enrolled in the study.The correlation between different bone metabolism types and bone mineral density was analysed.Results Forty-nine patients had normal BMD,and 54 patients had low BMD.In the low BMD group,the mean values of type I collagen cross-linked C-telopeptideβ-collagen specific sequence(β-CTX),osteocalcin(OC)and N-terminal propeptide of type I precollagen(P1 NP)were significantly higher than those in the normal BMD group(P<0.001).The low BMD group was divided into low to moderate and high conversion groups.The T value of femoral neck BMD in the high conversion group was-1.56±0.82,which was significantly lower than that in the low to medium conversion group(-1.01±0.92,P=0.029).However,no significant difference was found in T value of lumbar BMD between the two groups(P=0.080).In the low to medium conversion group,the BMD of femoral neck[(0.92±0.09)g/cm^(2)]after treatment was significantly improved compared with that before treatment[(0.89±0.08)g/cm^(2),P=0.022].However,in the high conversion group,no significant difference in BMD of femoral neck was found after the treatment(P=0.080).Conclusion The serum levels ofβ-CTX,OC and P1 NP are significantly increased in young adult patients with decreased bone mineral density,showing high loss of bone turnover high conversion bone loss.Patients with low to moderate conversion of bone mineral density reduction can be effectively treated through active basic disease inflammation control.However,more effective treatments should be explored for patients with high conversion of bone mineral density reduction.