血清suPAR、BDNF、sTWEAK水平与类风湿关节炎患者疾病活动度及骨密度的相关性

The correlation of serum suPAR,BDNF,sTWEAK levels and disease activity and bone density in patients with rheumatoid arthritis

目的研究血清可溶性尿激酶型纤溶酶原激活剂受体(suPAR)、脑源性神经营养因子(BDNF)、可溶性肿瘤坏死因子样细胞凋亡弱诱导因子(sTWEAK)水平与类风湿关节炎患者疾病活动度及骨密度的相关性。方法选取2021年1月至2023年7月解放军联勤保障部队第九四○医院内分泌科收治的类风湿关节炎患者140例为类风湿关节炎组,以及2021年1月至2023年7月至本院体检中心体检健康者70例为对照组。评估患者组疾病活动度,测定骨密度。检测对照组和类风湿关节炎组的血清suPAR、BDNF、sTWEAK水平。根据疾病活动度水平将类风湿关节炎组患者再分为低度亚组(2.6~3.2)、中度亚组(3.2~5.1)、高度亚组(>5.1)。比较类风湿关节炎组与对照组、3个亚组的suPAR、BDNF、sTWEAK、骨密度;分析suPAR、BDNF、sTWEAK与疾病活动度、骨密度的相关性;分析suPAR、BDNF、sTWEAK联合检测在预测疾病加重风险中的价值。结果类风湿关节炎组血清suPAR、BDNF、sTWEAK高于对照组(P<0.05)。高度亚组血清suPAR、BDNF、sTWEAK明显大于中度亚组和低度亚组(P<0.05),中度亚组血清suPAR、BDNF、sTWEAK明显大于低度亚组(P<0.05)。类风湿关节炎组前臂远端、腰椎L1-4、股骨颈、髋关节的骨密度小于对照组(P<0.05)。高度组前臂远端、腰椎L1-4、股骨颈、髋关节骨密度明显小于中度亚组和低度亚组,中度亚组前臂远端、腰椎L1-4、股骨颈、髋关节骨密度明显小于低度亚组(P<0.05)。血清suPAR、BDNF、sTWEAK与疾病活动度呈正相关,与前臂远端、腰椎L1-4、股骨颈、髋关节的骨密度呈负相关(P<0.05)。联合suPAR、BDNF、sTWEAK三项指标预测疾病活动度升高风险的AUC大于单独预测的AUC(P=0.000)。结论类风湿关节炎患者suPAR、BDNF、sTWEAK与疾病活动度呈正相关,与骨密度呈负相关,联合检测suPAR、BDNF、sTWEAK可为预测患者疾病未来变化趋势提供有效指导。

Objective To investigate the correlation between serum levels of soluble urokinasetype plasminogen activator re-ceptor(suPAR),brain-derived neurotrophic factor(BDNF),soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK)and disease activity and bone density in patients with rheumatoid arthritis.Methods We enrolled 140 patients with rheumatoid arthritis(patient group)admitted to the Endocrinology Department of the 940 Hospital of the Joint Logistics Support Force from January 2021 to July 2023 were selected and 70 healthy individuals(control group)who underwent physical examinations at our medical examina-tion center from January 2021 to July 2023.The activity of rheumatic diseases was evaluated,and bone density was measured.The serum levels of suPAR,BDNF,and sTWEAK were detected in the control and patient groups.According to the level of activity of rheumatic diseases,the patient group was further divided into three subgroups:high,medium,and low groups.The suPAR,BDNF,sTWEAK,and bone density were compared between the patient group and the control group,and among three subgroups(low,medium,and high groups).The correlation of suPAR,BDNF,sTWEAK and disease activity,bone density was analyzed.The value of combined detection of suPAR,BDNF,and sTWEAK in predicting the risk of disease progression was analyzed.Results The serum levels of suPAR(3.04±0.33 ng/mL),BDNF(10.36±1.21 ng/mL),and sTWEAK(152.12±15.47 pg/mL)in the patient group were higher than those in the control group(1.35±0.16 ng/mL,5.76±0.69 ng/mL,92.46±9.52 pg/mL)(P<0.05).The comparison of serum levels of suPAR,BDNF,and sTWEAK showed that the high group>moderate group>low group(P<0.05).The bone densities of the distal forearm(0.71±0.08 g/cm3),lumbar spine L1-4(0.94±0.12 g/cm3),femoral neck(0.90±0.10 g/cm3),and hip joint(0.83±0.09 g/cm3)in the patient group were lower than those in the control group(0.89±0.09 g/cm3,1.16±0.14 g/cm3,1.08±0.12 g/cm3,1.13±0.14 g/cm3)(P<0.05).The comparison of bone densities of the distal forearm,lumbar vertebrae L1-4,femoral neck,and hip joints showed that high group<moderate group<low group(P<0.05).SuPAR,BDNF,and sTWEAK were positively correlated with disease activity,and negatively correlated with bone densities of the distal forearm,lumbar spine L1-4,femo-ral neck,and hip joints(P<0.05).The combination of suPAR,BDNF,and sTWEAK showed a higher AUC(0.914)in predicting the risk of increased disease activity compared to the single predicted AUC(0.769,0.799,0.785)(P<0.05).Conclusion SuPAR,BDNF,and sTWEAK are positively correlated with disease activity and negatively correlated with bone density in patients with rheumatoid arthritis.Combined detection of suPAR,BDNF,and sTWEAK can provide effective guidance for predicting disease trends in pa-tients.