CAJ | 학술논문

目的探讨类风湿关节炎(RA)患者外周血β-连环蛋白和DKK1水平的变化及其与关节损伤的相关性.方法采用双能X线骨密度仪测量108例RA患者(观察组)和1 10例健康体检者(对照组)股骨(股骨颈、Ward区、大转子、总股骨区)和腰椎(L2.3.4)的骨密度,所有RA患者摄双手X线并进行Sharp评分;采用酶联免疫吸附试验法检测两组外周血β-连环蛋白和DKK1水平.多元分析采用多元线性回归和Logistic回归分析.结果观察组外周血DKK1水平较对照组明显升高[(8.2±5.0)mg/L比(6.1±4.2)mg/L],差异有统计学意义(t=2.452,P=0.025),β-连环蛋白水平与对照组比较差异无统计学意义(t=15.947,P=0.142).RA患者各测定部位的骨密度均明显低于对照组,差异有统计学意义(P＜0.01);观察组骨质疏松发生率为31.5％(34/108),明显高于对照组的15.5％ (17/110),差异有统计学意义(x2=9.289,P=0.005).相关性分析显示:RA患者外周血DKK1水平与红细胞沉降率(ESR)、28个关节疾病活动性评分(DAS28)、碱性磷酸酶(AKP)和双手X线关节间隙狭窄评分呈正相关(P＜ 0.01或＜0.05);外周血β-连环蛋白水平与ESR和AKP呈正相关(P＜ 0.01或＜0.05).多元线性回归分析显示:病程、健康状况问卷(HAQ)、DKK1影响双手X线关节间隙狭窄评分;而年龄、病程、HAQ影响双手X线骨侵蚀评分.多元Logistic回归分析发现:双手X线Sharp评分为RA患者股骨发生骨质疏松的危险因素;而年龄为RA患者腰椎发生骨质疏松的危险因素.结论 RA患者外周血DKK1水平明显升高,β-连环蛋白水平无明显变化;外周血DKK1水平与RA患者疾病活动性和关节间隙狭窄相关.
목적 탐토류풍습관절염(RA)환자외주혈β-련배단백화DKK1수평적변화급기여관절손상적상관성.방법 채용쌍능X선골밀도의측량108례RA환자(관찰조)화1 10례건강체검자(대조조)고골(고골경、Ward구、대전자、총고골구)화요추(L2.3.4)적골밀도,소유RA환자섭쌍수X선병진행Sharp평분;채용매련면역흡부시험법검측량조외주혈β-련배단백화DKK1수평.다원분석채용다원선성회귀화Logistic회귀분석.결과 관찰조외주혈DKK1수평교대조조명현승고[(8.2±5.0)mg/L비(6.1±4.2)mg/L],차이유통계학의의(t=2.452,P=0.025),β-련배단백수평여대조조비교차이무통계학의의(t=15.947,P=0.142).RA환자각측정부위적골밀도균명현저우대조조,차이유통계학의의(P＜0.01);관찰조골질소송발생솔위31.5％(34/108),명현고우대조조적15.5％ (17/110),차이유통계학의의(x2=9.289,P=0.005).상관성분석현시:RA환자외주혈DKK1수평여홍세포침강솔(ESR)、28개관절질병활동성평분(DAS28)、감성린산매(AKP)화쌍수X선관절간극협착평분정정상관(P＜ 0.01혹＜0.05);외주혈β-련배단백수평여ESR화AKP정정상관(P＜ 0.01혹＜0.05).다원선성회귀분석현시:병정、건강상황문권(HAQ)、DKK1영향쌍수X선관절간극협착평분;이년령、병정、HAQ영향쌍수X선골침식평분.다원Logistic회귀분석발현:쌍수X선Sharp평분위RA환자고골발생골질소송적위험인소;이년령위RA환자요추발생골질소송적위험인소.결론 RA환자외주혈DKK1수평명현승고,β-련배단백수평무명현변화;외주혈DKK1수평여RA환자질병활동성화관절간극협착상관.
Objective To study the variation characteristics of peripheral blood β-catenin and DKK1 levels in patients with rheumatoid arthritis (RA) and the correlation with bone and joint damage.Methods One hundred and eight patients with RA (observation group) and 110 healthy individuals (control group) were selected.The bone mineral density(B MD) in the femur (femur neck,Ward area,greater trochanter,total femur area) and lumbar spine (L2,3,4) were measured by dual-energy X-ray absorptiometry instrument.X-ray for two hands were evaluated according to the Sharp score.The peripheral blood β-catenin and DKK1 levels were detected by enzyme-linked immunosorbent assay (ELISA).Multiple analysis was completed by multiple linear regression and Logistic regression.Results The peripheral blood DKK1 level in observation group was significantly higher than that in control group [(8.2 ±5.0) mg/L vs.(6.1 ±4.2)mg/L],there was statistical difference (t =2.452,P =0.025),but there was no statistical difference in β-catenin level between the 2 groups (t =15.947,P =0.142).Compared to control group,patients with RA had lower BMD at femur and lumbar spine (P ＜ 0.01).The incidence of osteoporosis in observation group was significantly higher than that in control group [31.5％ (34/108) vs.15.5％ (17/110)],there was statistical difference (x2 =9.289,P =0.005).The correlation analysis results showed that the peripheral blood DKK1 was positive correlation with erythrocyte sedimentation rate (ESR),28-jonit disease activity score (DAS28),alkaline phosphatase (AKP) and two hands X-ray joint narrowing space score in patient with RA (P ＜ 0.01 or ＜ 0.05) ;the peripheral blood β-catenin level was positively correlated with ESR and AKP (P ＜ 0.01 or ＜ 0.05).The multiple linear regression results showed that the disease duration,health assessment questionnaires (HAQ),DKK1 influenced two hands X-ray joint narrowing space score; but the age,disease duration,HAQ influenced two hands X-ray bony erosion score.The multiple Logistic regression results showed that the two hands X-ray Sharp score was the risk factor of osteoporosis at femur in patients with RA; but the age was the risk factor of osteoporosis at lumbar in patients with RA.Conclusions Peripheral blood DKK1 level in patients with RA increases significantly,while there is no apparent alteration in β-catenin level.Peripheral blood DKK1 level is correlated with disease activity and joint space narrow score.