脂肪因子在银屑病关节炎骨质破坏中的意义

发布时间：2018-10-23 19:41

【摘要】：背景银屑病关节炎(PsA)有显著的骨质破坏倾向；代谢综合征在PsA中发病率很高；脂肪因子(尤其是瘦素和脂联素)参与代谢综合征的发病,最近研究认为它们同时又在风湿性疾病和骨代谢方面发挥作用。目的测量循环中破骨细胞相关细胞因子：肿瘤坏死因子-α(TNF-α)、核因子κB受体活化因子配体(RANKL)、骨保护素(OPG)和脂肪因子：瘦素、抵抗素、脂联素、趋化素、网膜素浓度,评估其与循环破骨细胞前体细胞(OCP)水平、影像学评分与疾病活动指数的关系,以了解脂肪因子在PsA骨质破坏中的意义。方法PsA患者41例,设无关节炎的银屑病患者20例,健康志愿者24例为对照。PsA患者采用PsAJAI评估关节炎活动度,改良Sharp评分、巴氏放射学指数(BASRI)评估骨侵蚀情况。取外周血,ELISA法检测血浆中的TNF-a、RANKL、OPG、瘦素、抵抗素、脂联素、趋化素、网膜素浓度。以外周血单个核细胞经体外RANKL和巨噬细胞集落刺激因子(M-CSF)刺激后生成的OC计数来反应OCP水平。比较各组的细胞因子和脂肪因子水平及其与骨侵蚀情况和疾病活动指数的关系。结果与对照组相比,PsA患者血浆TNF-α、RANKL、OCP、瘦素、网膜素浓度较高,而脂联素、趋化素、浓度较低。血TNF-α、RANKL、瘦素、网膜素浓度与OCP正相关,而血脂联素浓度与OCP负相关。血TNF-α、RANKL、瘦素与PsAJAI正相关。TNF-a与影像学评分正相关。结论本研究显示,PsA患者血浆OCP增加,且存在骨重建相关的细胞因子及脂肪因子水平的紊乱。PsA患者循环瘦素、网膜素水平升高,可能有助于关节炎骨破坏的发生。脂肪因子在调节PsA骨破坏方面具体机制,有待进一步研究。这可能为临床治疗PsA寻找有效的干预靶点提供依据。
[Abstract]:Background (PsA) of psoriatic arthritis has a significant tendency to destroy bone; metabolic syndrome is very high in PsA; adipose factors (especially leptin and adiponectin) are involved in the pathogenesis of metabolic syndrome. Recent studies suggest that they also play a role in rheumatic diseases and bone metabolism. Objective to measure the concentrations of osteoclast associated cytokines: tumor necrosis factor- 伪 (TNF- 伪), nuclear factor- 魏 B receptor activator ligand (RANKL), osteoprotegerin (OPG) and fat factors: leptin, resistin, adiponectin, chemotactic factor and omental hormone. To evaluate the relationship between (OCP) level of circulating osteoclast precursor cells, imaging score and disease activity index, and to understand the significance of fat factor in bone destruction of PsA. Methods 41 patients with PsA, 20 patients with psoriasis without arthritis and 24 healthy volunteers were selected as control. PsAJAI was used to evaluate arthritis activity, modified Sharp score and Pap radiology index (BASRI) to evaluate bone erosion in PsA patients. The concentrations of TNF-a,RANKL,OPG, leptin, resistin, adiponectin, chemoattractant and omentin in plasma were determined by ELISA method. The OC count of peripheral blood mononuclear cells stimulated by RANKL and macrophage colony stimulating factor (M-CSF) was used to reflect the OCP level. The levels of cytokines and fat factors in each group and their relationship with bone erosion and disease activity index were compared. Results compared with the control group, plasma TNF- 伪, RANKL,OCP, leptin and omental hormone concentrations in PsA patients were higher, but adiponectin and chemoattractant concentrations were lower. Serum TNF- 伪, RANKL, leptin and omental hormone concentrations were positively correlated with OCP, while serum adiponectin concentrations were negatively correlated with OCP. Serum TNF- 伪, RANKL, leptin were positively correlated with PsAJAI, and TNF-a was positively correlated with imaging score. Conclusion this study showed that plasma OCP increased in patients with PsA, and there was a disturbance of cytokines and fat factors related to bone remodeling. The elevated levels of circulating leptin and omentin in patients with PsA may contribute to the occurrence of bone destruction in arthritis. The specific mechanism of fat factor in regulating PsA bone destruction needs further study. This may provide evidence for clinical treatment of PsA to find effective intervention targets.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R758.63

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