外周血核因子κB受体激活剂配体/护骨素比值在类风湿关节炎患者骨质疏松性骨折中的意义
외주혈핵인자κB수체격활제배체/호골소비치재류풍습관절염환자골질소송성골절중적의의
Association between serum RANKL/OPG ratio and osteoporotic fracture in patients with rheumatoid arthritis
  • 万方数据
    中华全科医师杂志 중화전과의사잡지
    CHINESE JOURNAL OF GENERAL PRACTITIONERS
    2015年 2期 121-126 ,共6页

    刘文%刘童%徐胜前%马喜喜%胡琳玮%彭丽萍%徐建华

    류문%류동%서성전%마희희%호림위%팽려평%서건화

    关节炎,类风湿%骨折%骨质疏松%核因子κB受体活化因子 關節炎,類風濕%骨摺%骨質疏鬆%覈因子κB受體活化因子
    관절염,류풍습%골절%골질소송%핵인자κB수체활화인자
    Arthritis,rheumatoid%Fractures,bone%Osteoporosis%Receptor activator of nuclear factor kappa B
    目的 探讨外周血核因子κB受体激活剂配体(RANKL)和护骨素(OPG)水平的变化在类风湿关节炎(RA)患者合并骨质疏松性骨折(OPF)中的意义.方法 选择2010-2012年安徽医科大学第一附属医院风湿科住院的RA患者384例为RA组,年龄16 ～ 82岁,平均(49±14)岁;并根据RA组年龄和性别构成匹配入选158名健康人为对照组,年龄24 ～ 76岁,平均(50±11)岁.严格按照OPF定义并参考X线片判断两组OPF发生情况,以双能X线骨密度吸收法测定其骨密度(股骨区+腰椎2～4),酶联免疫法检测外周血RANKL和OPG水平.比较两组发生OPF的情况、外周血RANKL和OPG水平、骨密度值及其骨质疏松发生率.结果 384例RA患者OPF发生率21.35％(82例),明显高于对照组的3.80％ (6/158)(x2=25.371,P ＜0.01).与健康对照组比较,RA患者外周血RANKL水平(0.150±0.143比0.1叭±0.066,t=4.178,P＜0.000 1)、OPG水平(0.457±0.293比0.359 ±0.216,t=3.347,P=0.001)和RANKL/OPG比值(0.41 ±0.35比0.34±0.20,t=2.111,P=0.036)均明显升高.327例RA患者在各测定部位的骨密度均明显低于正常组(P＜0.01),骨质疏松发生率为37.00％(121/327),明显高于健康对照组的13.92％(22/158)(x2=27.291,P＜0.01).发生OPF的RA患者组较无OPF组具有更高的骨质疏松发生率(x2=38.186,P＜0.01)、更大的年龄(t=4.377,P＜0.01)、更长的病程(t=2.612,P=0.009)、更高的RANKL水平(t =3.554,P=0.01)、更高的RANKL/OPG比值(t=2.651,P=0.010)、更高的健康问卷评分(t=2.418,P=0.016)、更低的血清游离钙水平(=2.183,P=0.030)、更低的血红蛋白水平(=2.125,P =0.036)、更高的双手X线Sharp评分(t=2.747,P=0.007)、更差的X线分期构成(x2=7.856,P =0.049)、更高的糖皮质激素使用率(x2 =9.066,P =0.003).服用糖皮质激素的RA患者具有更高的骨质疏松发生率(x2=7.489,P=0.006)和OPF发生率(x2=9.066,P=0.003).logistic Regression (Backward LR法)分析显示,年龄(OR=1.029,P=0.039,95％ CI:1.001 ～1.057)和骨质疏松的发生(OR=3.159,P=0.001,95％ CI:1.562～6.385)、RANKL/OPG比值(OR =3.516,P =0.013,95％ CI:1.305 ～9.647)为RA患者发生OPF的危险因素.结论 RA患者OPF发生率为21.35％,约是正常对照组的5.6倍,年龄、病程和外周血RANKL/OPG比值是RA发生OPF的危险因素,也与糖皮质激素的使用有关.
    목적 탐토외주혈핵인자κB수체격활제배체(RANKL)화호골소(OPG)수평적변화재류풍습관절염(RA)환자합병골질소송성골절(OPF)중적의의.방법 선택2010-2012년안휘의과대학제일부속의원풍습과주원적RA환자384례위RA조,년령16 ～ 82세,평균(49±14)세;병근거RA조년령화성별구성필배입선158명건강인위대조조,년령24 ～ 76세,평균(50±11)세.엄격안조OPF정의병삼고X선편판단량조OPF발생정황,이쌍능X선골밀도흡수법측정기골밀도(고골구+요추2～4),매련면역법검측외주혈RANKL화OPG수평.비교량조발생OPF적정황、외주혈RANKL화OPG수평、골밀도치급기골질소송발생솔.결과 384례RA환자OPF발생솔21.35％(82례),명현고우대조조적3.80％ (6/158)(x2=25.371,P ＜0.01).여건강대조조비교,RA환자외주혈RANKL수평(0.150±0.143비0.1팔±0.066,t=4.178,P＜0.000 1)、OPG수평(0.457±0.293비0.359 ±0.216,t=3.347,P=0.001)화RANKL/OPG비치(0.41 ±0.35비0.34±0.20,t=2.111,P=0.036)균명현승고.327례RA환자재각측정부위적골밀도균명현저우정상조(P＜0.01),골질소송발생솔위37.00％(121/327),명현고우건강대조조적13.92％(22/158)(x2=27.291,P＜0.01).발생OPF적RA환자조교무OPF조구유경고적골질소송발생솔(x2=38.186,P＜0.01)、경대적년령(t=4.377,P＜0.01)、경장적병정(t=2.612,P=0.009)、경고적RANKL수평(t =3.554,P=0.01)、경고적RANKL/OPG비치(t=2.651,P=0.010)、경고적건강문권평분(t=2.418,P=0.016)、경저적혈청유리개수평(=2.183,P=0.030)、경저적혈홍단백수평(=2.125,P =0.036)、경고적쌍수X선Sharp평분(t=2.747,P=0.007)、경차적X선분기구성(x2=7.856,P =0.049)、경고적당피질격소사용솔(x2 =9.066,P =0.003).복용당피질격소적RA환자구유경고적골질소송발생솔(x2=7.489,P=0.006)화OPF발생솔(x2=9.066,P=0.003).logistic Regression (Backward LR법)분석현시,년령(OR=1.029,P=0.039,95％ CI:1.001 ～1.057)화골질소송적발생(OR=3.159,P=0.001,95％ CI:1.562～6.385)、RANKL/OPG비치(OR =3.516,P =0.013,95％ CI:1.305 ～9.647)위RA환자발생OPF적위험인소.결론 RA환자OPF발생솔위21.35％,약시정상대조조적5.6배,년령、병정화외주혈RANKL/OPG비치시RA발생OPF적위험인소,야여당피질격소적사용유관.
    Objective To investigate the value of serum receptor activator of nuclear factor kappa B ligand (RANKL)/osteoprotegrin (OPG) ratio in osteoporotic fracture (OPF) of patients with rheumatoid arthritis (RA).Methods Three hundred and eighty four RA patients with mean age of (49 ± 14) y (16-82) admitted in the First Affiliated Hospital of Anhui Medical University from 2010 to 2013 and 158 sex-and age-matched healthy subjects were enrolled in the study.OPF was diagnosed by X-ray examination and BMDs of femur and lumbar spine 2-4 (L2-4) were measured by dual energy X-ray absorptiometry.Levels of RANKL and OPG in the peripheral blood of 220 RA patients and 100 normal subjects were detected by ELISA method.Results Eighty-two cases of OPF was diagnosed in 384 RA patients (21.35％),the rate was higher than that in controls (3.80％,6/158,x2 =25.371,P ＜0.01).The peripheral blood levels of RANKL (0.150 ± 0.143 vs.0.101 ± 0.066,t =4.178,P ＜ 0.01),OPG (0.457 ± 0.293 vs.0.359 ±0.216,t=3.347,P=0.001) and ratio of RANKL/OPG (0.41 ±0.35 vs.0.34±0.20,t =2.111,P=0.036) in RA patients were significantly higher than those in control group.In comparison with normal controls,BMDs of all detected regions in RA were decreased significantly (P ＜0.01).The incidence of osteoporosis in RA (121/327,37％) was higher than that in normal controls (22/158,13.92％) (x2 =27.291,P ＜ 0.01).RA patients with OPF had higher age (t =4.377,P ＜ 0.01),longer duration of disease (t =2.612,P =0.009),higher RANKL level (t =3.554,P =0.001),higher RANKL/OPG ratio (t =2.651,P =0.010),higher health assessment questionnaires (HAQ) score (t =2.418,P =0.016),lower serum calcium level (t =2.183,P =0.030),lower hemoglobin level (t =2.125,P =0.036),higher Sharp score in hands X-ray examination (t =2.747,P =0.007),worse X-ray stage (x2 =7.856,P =0.049),higher glucocorticoid utilization rate (x2 =9.066,P =0.003) and higher incidence of osteoporosis (x2 =38.186,P ＜ 0.01),compared with patients without OPF.RA patients taking corticosteroids had higher incidence of osteoporosis (x2 =7.489,P =0.006) and higher incidence of OPF (x2 =9.066,P =0.003).Logistic regression analysis showed that age (OR =1.029,P =0.039,95％ CI:1.001-1.057)and the occurrence of osteoporosis (OR =3.159,P =0.001,95％ CI:1.562-6.385),RANKL/OPG ratio (OR =3.516,P =0.013,95 ％ CI:1.305-9.647) were risk factors for RA patients with OPF.Conclusion A higher incidence of OPF is prevalent in RA patients,and age,osteoporosis,taking glucocorticoids and RANKL/OPG ratio are risk factors for OPF in RA patients.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문