血清TRAP-5b、β-CTX及维生素D水平与类风湿关节炎合并骨质疏松性骨折的相关性

Correlation of serum TRAP-5b,β-CTX,vitamin D levels and rheumatoid arthritis complicated with osteoporotic fractures

目的研究血清酒石酸抗性酸性磷酸酶5b(tartrate resistant acid phosphatase-5b,TRAP-5b)、β-胶原降解产物(β-collagen degradation product,β-CTX)及维生素D水平与类风湿关节炎(rheumatoid arthritis,RA)合并骨质疏松(osteporsis,OP)性骨折的相关性。方法选择山西医科大学第二医院2022年10月至2023年10月诊治的200例RA患者,收集患者临床资料,并检测患者血清TRAP-5b、β-CTX、维生素D水平、骨密度、骨代谢标志物,根据是否发生OP性骨折分为RA组和RA-OP组,比较两组血清TRAP-5b、β-CTX、维生素D水平、骨密度、骨代谢标志物水平,并分析血清TRAP-5b、β-CTX及维生素D水平与类风湿关节炎合并骨质疏松性骨折的相关性。结果RA患者血清TRAP-5b、β-CTX水平高于健康对照组,维生素D水平低于健康对照组(t=12.27、20.01、7.35,P<0.05);两组患者性别、身体质量指数、糖尿病、高血压、吸烟和饮酒发生率比较,差异均无统计学意义(t=1.18、0.96、0.55、1.84、0.13、0.30,P>0.05),但两组在年龄、血清TRAP-5b、β-CTX、维生素D和骨代谢标志物水平的比较,差异均有统计学意义(t=2.33、3.72、4.94、5.10、7.72、4.77、2.42、9.30、4.01、6.38、4.79,P<0.05)。Logistic回归分析显示血清TRAP-5b、β-CTX、维生素D和骨代谢标志物水平均是影响RA患者发生OP的独立危险因素(P<0.05);血清TRAP-5b、β-CTX分别与血清PINP、NTx、PTH、BALP、BGP呈正相关(r=0.811、0.778、0.747、0.675、0.614;0.685、0.513、0.405、0.612、0.518),与腰椎BMD和股骨近端BMD呈负相关(r=-0.488、-0.512;-0.526、-0.502);血清维生素D与血清PINP、NTx、PTH、BALP、BGP呈负相关(r=-0.728、-0.640、-0.604、-0.622、-0.545),与腰椎BMD和股骨近端BMD呈正相关(r=0.519、0.492)(P<0.05)。结论血清TRAP-5b、β-CTX及维生素D水平与RA患者OP的发生密切相关,血清TRAP-5b和β-CTX水平异常升高、维生素D水平异常降低,均提示RA患者OP发生风险增加。

ObjectiveTo investigate the correlation of serum tartrate-resistant acid phosphatase 5b(TRAP-5b),β-collagen degradation products(β-CTX),vitamin D levels and rheumatoid arthritis(RA)complicated with osteoporosis(OP)fractures.MethodsA total of 200 RA patients diagnosed and treated in our hospital from Oct.2022 to Oct.2023 were selected.Clinical data of patients were collected,and serum TRAP-5b,β-CTX,vitamin D levels,bone mineral density and bone metabolism markers were detected.They were divided into RA group and RA-OP group according to whether OP fracture occurred.The above indexes were compared and their correlation with osteoporotic fractures in rheumatoid arthritis was analyzed.ResultsThe levels of serum TRAP-5b andβ-CTX in RA patients were higher than those in healthy control group,and the levels of vitamin D were lower(t=12.27,20.01,7.35,P<0.05).There was no statistically significant difference in gender,body mass index,diabetes,hypertension,smoking and drinking incidence between the two groups(t=1.18,0.96,0.55,1.84,0.13,0.30,P>0.05),but there was statistically significant difference in gender composition,serum TRAP-5b,β-CTX,vitamin D and bone metabolism markers between the two groups(t=2.33,3.72,4.94,5.10,7.72,4.77,2.42,9.30,4.01,6.38,4.79,P<0.05).Logistic regression analysis showed that the levels of serum TRAP-5b,β-CTX,vitamin D and bone metabolism markers were independent risk factors for OP in RA patients(P<0.05).Serum TRAP-5b andβ-CTX were positively correlated with serum PINP,NTx,PTH,BALP and BGP,respectively(r=0.811,0.778,0.747,0.675,0.614;0.685,0.513,0.405,0.612,0.518),and negatively correlated with lumbar BMD and proximal femoral BMD(r=-0.488,-0.512;-0.526,-0.502);Serum vitamin D was negatively correlated with serum PINP,NTx,PTH,BALP,BGP(r=-0.728,-0.640,-0.604,-0.622,-0.545),and positively correlated with lumbar BMD and proximal femur BMD(r=0.519,0.492)(P<0.05).ConclusionsSerum levels of TRAP-5b,β-CTX and vitamin D are closely related to the occurrence of OP in RA patients.Abnormal increase of serum levels of TRAP-5b andβ-CTX and abnormal decrease of vitamin D suggest an increasing risk of OP in RA patients.