中华风湿病学杂志
中華風濕病學雜誌
중화풍습병학잡지
CHINESE JOURNAL OF RHEUMATOLOGY
2013年
7期
468-473
,共6页
马喜喜%徐胜前%沈晓濛%刘童%胡琳玮%徐建华
馬喜喜%徐勝前%瀋曉濛%劉童%鬍琳瑋%徐建華
마희희%서성전%침효몽%류동%호림위%서건화
关节炎,类风湿%关节疾病%β-连环蛋白%Dickkopf 1蛋白
關節炎,類風濕%關節疾病%β-連環蛋白%Dickkopf 1蛋白
관절염,류풍습%관절질병%β-련배단백%Dickkopf 1단백
Arthritis,rheumatoid%Joint diseases%β-catenin%DKK1
目的 探讨类风湿关节炎(RA)患者外周血β-连环蛋白(β-catenin)和Dickkopf 1蛋白(DKK1)水平的变化及其与RA骨与关节损伤的相关性.方法 采用双能X线骨密度吸收(DEXA)法测定113例RA患者和120名健康对照组骨密度,所有RA患者摄双手X线并进行Sharp评分;采用酶联免疫吸附法(ELISA)检测所有RA患者和健康对照组(55名)外周血β-连环蛋白和DKK1水平.计量资料比较采用t检验,率的比较采用x2检验,多元分析采用多元线性回归和Logistic回归分析.结果 ①RA患者外周血DKK1水平较对照组明显升高[(8±7)与(6±4)μg/ml,t=2.552,P=0.012],β-连环蛋白水平与健康对照组间差异无统计学意义(P＞0.05).②RA患者各测定部位的骨密度均明显低于健康对照组(P＜0.01);RA组骨质疏松发生率为31.9％(36/113),明显高于健康对照组15.0％(18/120)(x2=9.290,P=0.002).③RA患者中骨质疏松组的年龄、肿胀关节数、肿胀关节指数、外周血碱性磷酸酶(AKP)水平、双手X线关节间隙狭窄评分、双手X线骨侵蚀评分和双手X线Sharp评分均明显高于无骨质疏松组(P＜0.05).④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)、AKP和双手X线关节间隙狭窄评分呈正相关(P＜0.05);β-连环蛋白水平与ESR和AKP呈正相关(P＜0.05).⑤线性回归分析显示:病程(b =0.709,t=9.560,P＜0.01,95％ CI:2.154 ～3.286)、HAQ (b=0.151,t=2.052,P=0.043,95％CI:0.234～15.243)、DKK1(b =0.286,t=2.057,P=0.043,95％CI:0.034～2.028)影响双手X线关节间隙狭窄评分(R2=0.580,F=24.745,P＜0.01).⑥Logistic回归分析发现:双手X线Sharp评分(OR=1.018,P＜0.01,95％CI:1.008～1.028)为RA患者股骨区发生骨质疏松的危险因素;年龄(0R=1.087,P=0.012,95％CI:1.019～1.159)为RA患者腰椎区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.
目的 探討類風濕關節炎(RA)患者外週血β-連環蛋白(β-catenin)和Dickkopf 1蛋白(DKK1)水平的變化及其與RA骨與關節損傷的相關性.方法 採用雙能X線骨密度吸收(DEXA)法測定113例RA患者和120名健康對照組骨密度,所有RA患者攝雙手X線併進行Sharp評分;採用酶聯免疫吸附法(ELISA)檢測所有RA患者和健康對照組(55名)外週血β-連環蛋白和DKK1水平.計量資料比較採用t檢驗,率的比較採用x2檢驗,多元分析採用多元線性迴歸和Logistic迴歸分析.結果 ①RA患者外週血DKK1水平較對照組明顯升高[(8±7)與(6±4)μg/ml,t=2.552,P=0.012],β-連環蛋白水平與健康對照組間差異無統計學意義(P＞0.05).②RA患者各測定部位的骨密度均明顯低于健康對照組(P＜0.01);RA組骨質疏鬆髮生率為31.9％(36/113),明顯高于健康對照組15.0％(18/120)(x2=9.290,P=0.002).③RA患者中骨質疏鬆組的年齡、腫脹關節數、腫脹關節指數、外週血堿性燐痠酶(AKP)水平、雙手X線關節間隙狹窄評分、雙手X線骨侵蝕評分和雙手X線Sharp評分均明顯高于無骨質疏鬆組(P＜0.05).④相關性分析顯示:RA患者外週血DKK1水平與紅細胞沉降率(ESR)、28箇關節疾病活動性評分(DAS28)、AKP和雙手X線關節間隙狹窄評分呈正相關(P＜0.05);β-連環蛋白水平與ESR和AKP呈正相關(P＜0.05).⑤線性迴歸分析顯示:病程(b =0.709,t=9.560,P＜0.01,95％ CI:2.154 ～3.286)、HAQ (b=0.151,t=2.052,P=0.043,95％CI:0.234～15.243)、DKK1(b =0.286,t=2.057,P=0.043,95％CI:0.034～2.028)影響雙手X線關節間隙狹窄評分(R2=0.580,F=24.745,P＜0.01).⑥Logistic迴歸分析髮現:雙手X線Sharp評分(OR=1.018,P＜0.01,95％CI:1.008～1.028)為RA患者股骨區髮生骨質疏鬆的危險因素;年齡(0R=1.087,P=0.012,95％CI:1.019～1.159)為RA患者腰椎區髮生骨質疏鬆的危險因素.結論 RA患者外週血DKK1水平明顯升高,β-連環蛋白水平無明顯變化;外週血DKK1水平與RA患者疾病活動性和關節間隙狹窄相關.
목적 탐토류풍습관절염(RA)환자외주혈β-련배단백(β-catenin)화Dickkopf 1단백(DKK1)수평적변화급기여RA골여관절손상적상관성.방법 채용쌍능X선골밀도흡수(DEXA)법측정113례RA환자화120명건강대조조골밀도,소유RA환자섭쌍수X선병진행Sharp평분;채용매련면역흡부법(ELISA)검측소유RA환자화건강대조조(55명)외주혈β-련배단백화DKK1수평.계량자료비교채용t검험,솔적비교채용x2검험,다원분석채용다원선성회귀화Logistic회귀분석.결과 ①RA환자외주혈DKK1수평교대조조명현승고[(8±7)여(6±4)μg/ml,t=2.552,P=0.012],β-련배단백수평여건강대조조간차이무통계학의의(P＞0.05).②RA환자각측정부위적골밀도균명현저우건강대조조(P＜0.01);RA조골질소송발생솔위31.9％(36/113),명현고우건강대조조15.0％(18/120)(x2=9.290,P=0.002).③RA환자중골질소송조적년령、종창관절수、종창관절지수、외주혈감성린산매(AKP)수평、쌍수X선관절간극협착평분、쌍수X선골침식평분화쌍수X선Sharp평분균명현고우무골질소송조(P＜0.05).④상관성분석현시:RA환자외주혈DKK1수평여홍세포침강솔(ESR)、28개관절질병활동성평분(DAS28)、AKP화쌍수X선관절간극협착평분정정상관(P＜0.05);β-련배단백수평여ESR화AKP정정상관(P＜0.05).⑤선성회귀분석현시:병정(b =0.709,t=9.560,P＜0.01,95％ CI:2.154 ～3.286)、HAQ (b=0.151,t=2.052,P=0.043,95％CI:0.234～15.243)、DKK1(b =0.286,t=2.057,P=0.043,95％CI:0.034～2.028)영향쌍수X선관절간극협착평분(R2=0.580,F=24.745,P＜0.01).⑥Logistic회귀분석발현:쌍수X선Sharp평분(OR=1.018,P＜0.01,95％CI:1.008～1.028)위RA환자고골구발생골질소송적위험인소;년령(0R=1.087,P=0.012,95％CI:1.019～1.159)위RA환자요추구발생골질소송적위험인소.결론 RA환자외주혈DKK1수평명현승고,β-련배단백수평무명현변화;외주혈DKK1수평여RA환자질병활동성화관절간극협착상관.
Objective To examine the plasma β-catenin and DKK1 levels in patients with rheumatoid arthritis (RA) and to explore their relationship with bone and joint damage in RA.Methods One hundred and thirteen patients with RA and 120 healthy individuals were recruited into this research.Bone mineral density (BMD) in the femur and lumbar spine were measured with dual-energy X-ray absorptiometry (DEXA).Radiographs for two hands were evaluated according to the Sharp's method.Serum levels of β-catenin and DKK1 in all patients with RA and healthy controls were detected by enzyme-linked immunosorbent assay (ELISA).The 2-tailed independent samples t test was used for measurement data.Chi-square test was used for the enumeration data.Correlation analysis,linear regression and Logistic regression analysis were used as appropriate statistical analysis.Results ① Significantly higher serum levels of DKK1 were observed in RA patients than that in healthy controls [(8±7) vs(6±4) μg/ml,t=2.552,P=0.012],while there was no sinnificant difference with regard to the levels of β-catenin between the two groups.② Compared to control groups,patients with RA had lower BMDs at femur and lumbar spine (P＜0.01).Furthermore,incidence of osteoporosis (OP) in RA (31.9％,36/113) was remarkablely higher than that in healthy subjects (15.0％,18/120) (x2=9.290,P=0.002).③ There were obvious discrepancies in age,swollen joint count (SJC),swollen joint count index (SJI),alkaline phosphatase (AKP),joint narrowing space score,joint erosion score,Sharp score between patients with osteoporosis and without osteoporosis (P＜0.05).④ In RA group,DKK1 level was posi-tively related with plasma erythrocyte sedimentation rates (ESR),28-jonit disease activity score (DAS28),AKP,joint narrowing space score (P＜0.05).Serum β-catenin level was associated with ESR,AKP in RA (P＜0.05).⑤ Multiple linear regression analysis indicated that in the RA group,disease duration (b=0.709,t=9.560,P＜0.01,95％CI:2.154-3.286),HAQ (b=0.151,t=2.052,P=0.043,95％CI:0.234-15.243),DKK1(b=0.286,t=2.057,P=0.043,95％CI:0.034-2.028)were the contributors for joint space narrow score(R2=0.580,F=24.745,P＜0.01).⑥ Multiple Logistic regression analysis showed that the Sharp score (OR=1.018,P＜0.01,95％CI:1.008-1.028) was the risk factor for the occurrence of osteoporosis at femur in RA,while age (OR=1.087,P=0.012,95％CI 1.019-1.159) was the risk factor for osteoporosis at lumbar spine.Conclusion Serum DKK1 levels in RA increase significantly,while there is no apparent alteration in plasma β-catenin.Serum DKK1 is correlated with disease activity and joint space narrow score.
