Bone metabolism changes of patients with connective tissue diseases and effects of YunKe on the patients with rheumatoid arthritis
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摘要:
目的：通过测定骨密度和骨代谢指标了解结缔组织病患者骨质疏松的发生情况和骨代谢的变化情况，并评价云克治疗类风湿关节炎（rheumatoid arthritis，RA）对骨代谢的影响。方法：选取2016年2月—2017年2月于江苏大学附属医院风湿免疫科住院患者共280例，其中系统性红斑狼疮（systemic lupus erythematosus，SLE）75例，原发性干燥综合征（primary Sjogren syndrome，pSS）45例，RA 160例。采用双能X线法测定患者腰椎和髋部骨密度，采用电化学发光免疫分析法检测骨钙素（osteocalcin，OC）、Ⅰ型原胶原N端前肽（N-terminal propeptide of typeⅠ procollagen，PINP）和Ⅰ型胶原C端肽交联（C-terminal cross-linking telopeptide of type Ⅰ collagen，CTX）。分别分析骨代谢指标OC、PINP和CTX与患者年龄、病程、体重指数（body mass index，BMI）、C-反应蛋白（C-reactive protein，CRP）、红细胞沉降率（erythrocyte sedimentation rate，ESR）、补体C3、类风湿因子（rheumatoid factor，RF）、骨密度以及激素使用程度等因素的相关性。有70例RA患者给予云克治疗4个月，统计分析云克治疗前后骨代谢指标的差异。结果：280例结缔组织病患者骨量减少的发生率为27.7%，骨质疏松的发生率为21.5%。与SLE组比较，OC、PINP以及CTX水平在pSS组和RA组呈升高趋势；同时，pSS和RA患者的OC、PINP以及CTX水平在骨量正常组、骨量减少组和骨质疏松组呈逐渐升高的趋势。相关性分析发现，pSS患者骨代谢指标与RF呈显著正相关（OC：r=0.570，P=0.002；PINP：r=0.752，P < 0.001；CTX：r=0.660，P < 0.001）；SLE患者OC、PINP与髋部骨密度呈显著负相关（OC：r=-0.382，P=0.028；PINP：r=-0.527，P=0.002）；pSS患者OC、CTX与髋部骨密度呈显著负相关（OC：r=-0.471，P=0.013；CTX：r=-0.422，P=0.028）。与治疗前比较，云克治疗4个月后RA患者OC水平上升（P < 0.05），ESR水平下降（P < 0.05）；而PINP、CTX、CRP和骨密度无明显变化。结论：结缔组织病患者存在不同程度的骨代谢异常，骨质疏松发生率较高。骨代谢指标可早期预测骨量丢失情况。云克治疗有助于改善RA患者骨代谢。
Abstract:
Objective：To investigate the prevalence of osteoporosis and the changes of bone metabolic markers in patients with connective tissue disease（CTD）by measuring bone mineral density and bone metabolism index，and evaluate the effect of YunKe on the patients with rheumatoid arthritis（RA）. Methods：In the study，280 patients with connective tissue disease in the Affiliated Hospital of Jiangsu University from February 2016 to February 2017 were recruited. Among them，there were 75 cases of systemic lupus erythematosus（SLE），45 cases of primary Sjogren syndrome（pSS）and 160 cases of RA. Bone mineral density（BMD）of lumbar spine L1-L4 and the proximal femur were measured using dual energy X-ray absorptiometry（DXA）in all patients. The bone metabolic markers，serum osteocalcin（OC），N-terminal propeptide of type Ⅰ procollagen（PINP）and C-terminal cross-linking telopeptide of type I collagen（CTX）were also detected by electro chemiluminescence immunoassay. The bone metabolism index OC，PINP and CTX were analyzed respectively with age，duration，body mass index（BMI），C-reactive protein（CRP）and erythrocyte deposition rate（ESR），complement C3，rheumatoid factor（RF），bone density，and hormone usage. Seventy RA patients were treated with YunKe for 4 months and the effect of YunKe on the bone metabolic markers was evaluated. Results：A total of 280 patients had a mean age of（53.96 ± 14.10）years，mean duration of（94.88 ± 108.40）months and mean BMI of（21.84 ± 2.27）kg/m2，in which 27.7% patients showed osteopenia and 21.5% patients showed osteoporosis. Compared with the SLE patients，OC，PINP and CTX levels gradually increased in pSS and RA patients. OC，PINP and CTX levels in pSS and RA patients also gradually increased in the osteopenia group and the osteoporosis group. There were significant differences between normal bone mass group and osteoporosis group（P < 0.05）. OC，PINP and CTX levels in pSS were positively correlated with serum RF（OC：r1=0.570，P=0.002；PINP：r2=0.752，P=0.000；CTX：r3=0.660，P=0.000）；OC and PINP levels in SLE were negatively correlated with BMD of hip（OC：r1=-0.382，P=0.028；PINP：r2=-0.527，P=0.002）；OC and CTX levels in pSS were negatively correlated with BMD of hip（OC：r1=-0.471，P=0.013；CTX：r3=-0.422，P=0.028）. The level of OC was significantly increased（P < 0.05）and the level of ESR was significantly decreased（P < 0.05）after treated with YunKe. The differences of OC and ESR were statistically significant，while the levels of PINP，CTX，CRP and BMD were no significant differences between before and after 4 months of the treatment. Conclusion：Osteoporosis in connective tissue disease patients is common and there are different degrees of bone metabolism changes. Bone metabolic markers can probably predict bone loss in the early stage. YunKe has good effect on bone metabolism for RA.
