类风湿关节炎患者血清骨代谢产物的变化及意义

发布时间：2018-05-25 19:56

  本文选题：类风湿关节炎 + 破骨细胞　； 参考：《广东医学》2017年03期

【摘要】：目的探讨骨代谢产物在类风湿关节炎(RA)患者血清中的浓度变化及临床意义。方法选择64例住院RA患者,30例同期健康体检者为对照组。检测患者血清:BGP、β-CTX、PINP、25-(OH)Vit D3、ESR、CRP、RF、抗-CCP抗体。计算RA患者疾病活动指数(DAS28评分);用DEXA检测各组受试者腰椎及股骨骨密度(BMD)。用SPSS 20.0统计软件分析。结果 RA组β-CTX(0.78±0.75)ng/m L,高于对照组(0.40±0.19)ng/m L,差异有统计学意义(P0.05);RA组PINP(51.66±33.21)ng/m L、BGP(21.98±13.94)ng/m L、(25-OH)Vit D3(19.01±9.71)ng/m L低于对照组的(67.43±24.81)ng/m L、(30±8.67)ng/m L、(38.65±8.34)ng/m L,差异有统计学意义(P均0.05);RA组腰椎(L2-L4)、股骨颈(N)、Ward's三角区BMD分别为(-1.52±1.60)g/cm~2、(-1.64±1.00)g/cm~2、(-2.77±1.21 g/cm~2)均低于对照组的(1.13±0.27)g/cm~2、(0.45±0.32)g/cm~2、(-0.35±0.31)g/cm~ 2,差异有统计学意义(P均0.05)。β-CTX与DAS 28评分呈正相关(r=0.564,P0.05),多元相关分析显示BMD与DAS28负相关(r=-2.07,P0.05),与抗-CCP、GPI无明显相关(P均0.05);BMD(N)与(25-OH)Vit D3呈负相关(r=-0.348,P0.05),BMD(W)与病程呈负相关(r=-0.348,P0.05);PINP与RF、CRP、CCP、ESR无明显相关(P均0.05)。结论本研究显示RA患者存在明显的骨质疏松,并显示骨代谢异常主要表现为β-CTX显著高于对照组,提示破骨细胞活性增加不仅导致RA患者骨关节破坏而且导致继发性骨质疏松(OP)的发生;疾病越活动越容易出现OP,维生素D的缺乏在RA并发骨质疏松中起到一定的作用。提示在RA治疗中应该尽早干预OP,积极治疗RA同时补充维生素D有助于OP的防治。
[Abstract]:Objective to investigate the changes and clinical significance of bone metabolites in serum of patients with rheumatoid arthritis (RA). Methods 64 patients with RA and 30 healthy controls were selected as control group. The serum levels of BGP, 尾 -CTX, PINP, OHV Vit D3, ESRP, and anti-CCP antibodies were detected in patients with BGP, 尾 -CTX, PINPX and OHV Vit D3. The disease activity index (DAS 28) and bone mineral density (BMD) of lumbar vertebrae and femur were measured by DEXA. SPSS 20.0 statistical software was used to analyze the results. 缁撴灉 RA缁勎，

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