类风湿关节炎患者骨代谢指标水平、骨密度检验及其相关性分析

Levels of Bone metabolism index and bone mineral density detection and correlation analysis in patients with rheumatoid arthritis

目的:对类风湿关节炎(RA)患者骨代谢指标水平、骨密度进行检验并探讨其相关性。方法:回顾性分析2019年1月至2020年12月沈阳市骨科医院收治的168例RA患者的临床资料,以类风湿关节炎疾病活动度(DAS28)评分系统为依据,将RA患者分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级,选取同期40名健康体检者为对照组。比较各级别RA患者及对照组的血清骨代谢指标[25-羟基维生素D(25-OHVD)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、Ⅰ型前胶原氨基末端肽(P1NP)及N端中段骨钙素(N-MID)]水平,以及Ward三角区、股骨颈、腰椎L1~4正位骨密度(BMD)水平,采用Pearson分析法分析骨代谢指标水平和BMD的相关性。结果:Ⅱ、Ⅲ、Ⅳ级患者的N-MID、P1NP、25-OHVD水平均低于对照组,β-CTX水平均高于对照组,差异有统计学意义(P<0.05);Ⅰ级患者各指标水平与对照组比较,差异均无统计学意义(P>0.05);不同分级RA患者的N-MID、P1NP、25-OHVD水平比较,Ⅰ级>Ⅱ级>Ⅲ级>Ⅳ级;不同分级RA患者的β-CTX水平相比,Ⅰ级<Ⅱ级<Ⅲ级<Ⅳ级,差异均有统计学意义(P<0.05);Ⅲ、Ⅳ级患者Ward三角区、股骨颈及腰椎BMD水平均低于对照组,Ⅰ、Ⅱ级各部位BMD水平与对照组比较,差异无统计学意义(P>0.05);不同分级RA患者的BMD水平比较,Ⅰ级≈Ⅱ级>Ⅲ级>Ⅳ级,差异均有统计学意义(P<0.05);Pearson相关性分析显示,N-MID、P1NP、25-OHVD水平均与BMD水平呈正相关(r>0.9,P<0.05),β-CTX水平与BMD水平呈负相关(r=-0.965,P<0.05)。结论:RA患者病情越严重,BMD水平越低,骨代谢指标的异常变化越明显,其中N-MID、P1NP、25-OHVD水平均与BMD水平呈正相关,β-CTX水平与BMD水平呈负相关,因此骨代谢指标可用于评价RA患者骨质损伤程度。

Objective:To detect levels of bone metabolism index and bone mineral density(BMD)in patients with rheumatoid arthritis(RA)and to discuss their correlations.Methods:The clinical data of 168 RA patients admitted to Shenyang orthopedic hospital from January 2019 to December 2020 were retrospectively analyzed.Based on the rheumatoid arthritis disease activity scale(DAS28)scoring system,these RA patients were divided into grade I,grade II,grade III and grade IV.40 healthy subjects for the health examination were selected as control group.The levels of serum bone metabolism indexes[25-hydroxyvitamin D(25-OHVD),Beta C-terminal cross-linked telopeptides of type I collagen(β-CTX),type I procollagen N-terminal propeptide(P1NP)and osteocalcin in the n-terminal middle section(N-MID)]and the levels of bone mineral density(BMD)in Ward triangle,femoral neck and lumbar L1-4 were compared between the RA patients with different grades and the control group.Pearson analysis was used to analyze the correlations among the bone metabolism indexes and the BMD.Results:The levels of N-MID,P1NP and 25-OHVD in the patients with grade II,grade III and grade IV were lower than those in the control group,the levels ofβ-CTX were higher than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in each index between the grade I patients and the control group(P>0.05).The comparison of the levels of N-MID,P1NP and 25-OHVD showed that:grade I>grade II>grade III>grade IV;the comparison of the level ofβ-CTX showed that:grade I<grade II<grade III<grade IV;and the differences were statistically significant(P<0.05).The BMD levels of Ward’triangle,femoral neck and lumbar spine in the patients with grade III and IV were lower than those in the control group;however,there were no significant differences in the BMD level in each site among the patients grade I and grade II and the control group(P>0.05).The comparison of the BMD levels of the patients with different grades of RA showed that grade I≈grade II>grade III>grade IV,and the differences were statistically significant(P<0.05).Pearson correlation analysis showed that the levels of N-MID,P1NP and 25-OHVD were positively correlated with the BMD level(r>0.9,P<0.05),and the level ofβ-CTX was negatively correlated with the BMD level(r=-0.965,P<0.05).Conclusions:The more severe the condition of the RA patients is,the lower the BMD level is,and the more obvious the abnormal changes of bone metabolism indexes are.The levels of N-MID,P1NP and 25-OHVD are positively correlated with the BMD level,and the level ofβ-CTX is negatively correlated with the BMD level.Therefore,the bone metabolic markers can be used to evaluate the degree of bone damage in the RA patients.