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| 炎症、骨重建和类风湿关节炎全身骨量丢失的相关性研究 |
| Associations between inflammation, bone remodeling, and whole-body bone loss in patients with rheumatoid arthritis |
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| DOI：10.3969/j.issn.1006-7108.2019.05.016 |
| 中文关键词: 炎症 骨重建 骨量丢失 骨密度 类风湿关节炎 |
| 英文关键词:inflammation bone remodeling bone loss bone mineral density rheumatoid arthritis |
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| 中文摘要: |
| 目的 探讨炎症、骨重建和类风湿关节炎（rheumatoid arthritis，RA）全身骨量丢失的相关性。方法 纳入符合2010 年美国风湿病学会/欧洲抗风湿联盟RA分类标准的患者117例，采用酶联免疫吸附法测定RA患者和健康对照人群的血清肿瘤坏死因子（tumor necrosis factor α，TNF-α）、白介素-6（interleukin，IL-6）和核因子κB受体活化因子配体（receptor activator of nuclear factor-κB ligand，RANKL），采用电化学发光法检测RA患者血清I型胶原羧基端交联肽（C-terminal telopeptide of type I collagen，I-CTX）和I型胶原氨基端前肽（aminoterminal propeptide of type I collagen，PINP），通过双能X线吸收法测定患者腰椎和髋部骨密度（bone mineral density，BMD），运用Pearson’s相关系数分析血清TNF-α、IL-6、RANKL、I-CTX、PINP和RA患者腰椎及髋部骨密度的相关性。结果 纳入的患者中初发未治疗患者（初治组）为41例，其中骨量减低患者占46.3%，骨质疏松患者占24.4%；曾使用糖皮质激素和（或）传统缓解病情抗风湿药和（或）生物制剂和（或）双膦酸盐患者（复治组）为76例，其中骨量减低人群占28.9%，骨质疏松患者占44.7%。初治患者血清I-CTX、PINP与髋部骨密度呈显著负相关（P＜0.05）;复治患者血清TNF-α和IL-6水平显著高于对照组（P＜0.05），血清TNF-α水平与RANKL呈显著正相关（P＜0.05），血清IL-6与腰椎骨密度呈显著负相关（P＜0.05）。结论 骨转换增高可能是引起初治RA患者髋部骨量丢失的原因；持续的慢性炎症可能引起复治RA患者血清RANKL水平增加，导致患者腰椎骨量丢失。 |
| 英文摘要: |
| Objective To investigate the associations between inflammation, bone remodeling, and whole-body bone loss in patients with rheumatoid arthritis (RA). Methods All the patients fulfilled the revised criteria for classification of RA by the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010were recruited in this study. Enzyme linked immunosorbent assay (ELISA) was used to detect serum levels of tumor necrosis factor α (TNF-α), interleukin (IL-6), and receptor activator of nuclear factor-κB ligand (RANKL) in RA patients and the controls. Serum concentrations of C-terminal telopeptide of type I collagen (I-CTX) and total amino-terminal propeptide of type I collagen (PINP) were measured with electrochemiluminescence in RA patients. Bone mineral density (BMD) of the lumbar spine and total hip was evaluated using dual-energy X-ray absorptiometry in patients with RA. Associations between TNF-α, IL-6, RANKL, I-CTX, PINP, and BMD of the lumbar spine and total hip in RA patients were examined using Pearson’s correlation coefficients. Results One hundred and seventeen patients with RA were included in the study. Forty-one RA patients were untreated (Osteopenia: 46.3%; Osteoporosis: 24.4%) and seventy-six RA patients were treated with glucocorticoids and/or conventional disease-modifying anti-rheumatic drugs, and/or biological agents, and/or bisphosphonates previously (Osteopenia: 28.9%; Osteoporosis: 44.7%). Serum I-CTX and PINP were significantly correlated with low BMD at hip in untreated RA patients (P＜0.05). Serum TNF-α and IL-6 were significantly increased in treated RA patients compared with those in the controls (P<0.05). Serum TNF-α were significantly correlated with increased RANKL in treated RA patients (P<0.05). Serum levels of IL-6 were significantly correlated with low BMD of the lumbar spine in treated RA patients (P<0.05). Conclusion Increased bone remodeling rate may cause bone loss at hip in untreated RA patients. Chronic inflammation may cause increased serum levels of RANKL and lead to reduced BMD of the lumbar spine in treated RA patients. |
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