氧化应激和骨代谢水平与类风湿关节炎继发骨质疏松的相关性分析

Relationship between oxidative stress and bone metabolism and osteoporosis in patients with rheumatoid arthritis

目的探讨氧化应激和骨代谢水平与类风湿关节炎(RA)并发骨质疏松症(OP)的关系。方法回顾性分析2014年3月至2015年9月期间西安市第五医院收治的85例RA老年患者的临床资料,并选取同时期在我院进行体检年龄匹配的健康老年人60例为对照组。对比两组患者OP发病率、总Ⅰ型胶原氨基端延长肽(TPⅠNP)、β-胶原降解产物(β-CTx)和骨钙素N端中分子(N-MID)、晚期氧化蛋白产物(AOPP)、超氧化物歧化酶(SOD)水平,并对比RA合并OP及单纯RA患者的TPⅠNP、β-CTx和N-MID、AOPP、SOD水平。结果与对照组相比,RA组患者的OP发病率显著升高,差异有统计学意义(P<0.05);与对照组对比,RA组患者的TPⅠNP、N-MID、SOD显著降低,β-CTx、AOPP显著升高,差异有统计学意义(P<0.05);与单纯RA组对比,RA合并OP组患者的SOD水平显著降低,β-CTx和AOPP相反,差异有统计学意义(P<0.05)。经Person相关性分析显示,AOPP与SOD呈显著负相关(r=-0.503,P<0.01),与β-CTx及年龄呈显著正相关(r=0.314,P=0.01;r=0.52,P<0.01)。结论 RA患者OP发病率显著高于正常人,氧化应激反应与骨量减少存在显著相关性。检测氧化应激和骨代谢水平的变化对诊断和治疗RA合并OP具有重要意义。

Objective To investigate association between oxidative stress,bone metabolism and osteoporosis(OP) patients with rheumatoid arthritis(RA).Methods Retrospective investigation and analysis were carried out in clinical data of 85 cases of elderly patients with RA during March 2014 to September 2015 in Xi'an No.5 Hospital,and 60 healthy age-matched elderly were enrolled in control group.Compared the incidence of OP,the total collagen type Ⅰ amino-terminal extension of a peptide(TPⅠNP),β-collagen degradation products(β-CTx) and osteocalcin molecules in the N-terminal(N-MID),advanced oxidation protein products(AOPP),superoxide dismutase(SOD) levels between two groups of patients,and TPⅠNP,β-CTx and N-MID,AOPP,superoxide dismutase,SOD levels between RA patients with OP or RA patients.Results Compared with the control group,the incidence of RA patients with OP increased significantly,the difference is statistically significant(P<0.05).Compared with the control group,TPⅠNP,N-MID and SOD in RA patients significantly decreased,but CTx,AOPP were significantly increased,the difference is statistically significant(P<0.05).Compared with pure RA group,SOD in RA patients with OP significantly decreased,β-CTx and AOPP was the opposite,the difference was statistically significant(P<0.05).Pearson correlation analysis showed that AOPP had a significant negative correlation with SOD(r=-0.503,P<0.01),had a significant positive correlation with β-CTx and age(r=0.314,P=0.01;r=0.52,P<0.01).Conclusions The incidence of OP in RA patients was significantly higher than healthy subjects.There was a significant correlation between oxidative stress and bone loss.To detect the changes of oxidative stress and bone metabolism is of great significance for diagnosis and treatment of RA patients with OP.