類風濕關節炎合并骨質疏松患者骨代謝及炎癥因子的變化

朱丹燕　王丹丹　袁遠

[摘要] 目的 探討類風濕關節炎合并骨質疏松患者體內骨代謝和炎癥因子的變化。 方法 選取我院2016年7月～2017年9月收治的100例類風濕關節炎患者為觀察組，根據是否合并骨質疏松，分為合并骨質疏松組（58例）和非合并骨質疏松組（42例），并選取來我院體檢的50例健康人群為對照組，對比分析觀察組和對照組以及合并骨質疏松組和非合并骨質疏松組之間骨密度、骨鈣素（BGP）和骨保護素（OPG）等骨代謝指標以及C 反應蛋白（CRP）、炎癥因子白介素-1β（IL-1β）等炎癥因子的表達水平。 結果 與對照組相比，觀察組患者骨密度值顯著降低，差異有統計學意義（P<0.05）；體內血清骨鈣素水平顯著升高，差異有統計學意義（P<0.05）；血清骨保護素水平顯著降低，差異有統計學意義（P<0.05）；C 反應蛋白和炎癥因子白介素-1β水平均顯著升高，差異有統計學意義（P<0.05）。與非合并骨質疏松組相比，合并骨質疏松組患者血清骨保護素、C 反應蛋白以及炎癥因子白介素-1β水平均較高，差異有統計學意義（P<0.05）；而骨鈣素、骨密度水平無顯著差異（P>0.05）。 結論 類風濕性關節炎患者合并骨質疏松率的發生率較高，檢測患者體內骨鈣素（BGP）、骨保護素（OPG）、 C 反應蛋白（CRP）、炎癥因子白介素-1β（IL-1β）等骨代謝和炎癥因子的表達水平有利于疾病的診斷。

[關鍵詞] 類風濕關節炎；骨質疏松；骨代謝；炎癥因子

[中圖分類號] R580；R593.22 [文獻標識碼] A [文章編號] 1673-9701（2017）36-0019-04

[Abstract] Objective To investigate the changes of bone metabolism and inflammatory cytokines in the patients with rheumatoid arthritis complicated with osteoporosis. Methods A total of 100 patients with rheumatoid arthritis who were admitted to our hospital from July 2016 to September 2017 were selected as observation group. According to whether the patients were complicated with osteoporosis， they were divided into osteoporosis group（58 cases） and non-complicated osteoporosis group（42 cases）. 50 healthy people who were given physical examination in our hospital were selected as the control group. The bone metabolism indexes such as bone mineral density （BMD）， bone osteocalcin（BGP） and osteoprotegerin（OPG）， as well as the expression levels of C-reactive protein （CRP）， interleukin-1β （IL-1β） and other inflammatory factors were compared and analyzed between the observation group and the control group， and between the complicated osteoporosis group and non-complicated osteoporosis group. Results Compared with the control group， the BMD in the observation group was significantly lower， and the difference was statistically significant（P<0.05）； in vivo serum osteocalcin levels were significantly increased， and the difference was statistically significant（P<0.05）； serum osteoprotegerin level was significantly lower， and the difference was statistically significant（P<0.05）； C-reactive protein and inflammatory cytokines interleukin-1β levels were significantly increased， and the difference was statistically significant（P<0.05）. Compared with the non-complicated osteoporosis group， the serum osteoprotegerin， C-reactive protein and interleukin-1β levels in the patients in the complicated osteoporosis group were significantly higher， and the difference was statistically significant（P<0.05）； the osteocalcin and bone mineral density were not significantly different（P> 0.05）. Conclusion The incidence rate of rheumatoid arthritis complicated with osteoporosis is high. The detection of the expression levels of osteopontin （BGP）， osteoprotegerin （OPG）， C-reactive protein （CRP）， interleukin-1β （IL-1β） and other bone metabolism indexes and inflammatory cytokines in the patients is helpful for the diagnosis of the disease.

[Key words] Rheumatoid arthritis； Osteoporosis； Bone metabolism； Inflammatory factors

類風濕關節炎（rheumatoid arthritis，RA）[1]是一種病因未明的慢性、以炎性滑膜炎為主的系統性、自身免疫性疾病[2]，其臨床主要特征是累及手、足小關節的多關節、對稱性、侵襲性關節炎，常有晨僵，常伴有心臟[3]、呼吸系統[4]、腎臟[5]、神經系統等關節外器官受累，最終可導致關節的畸形，甚至功能的喪失。其病理表現主要為滑膜襯里細胞的增生、間質炎細胞的浸潤以及骨組織的破壞、血管翳的形成、大量微血管的新生等[6]。其發病機制尚未完全闡明，可能與患者感染、遺傳、激素[7]水平等相關。……