类风湿关节炎中影响骨质流失的因素：一项纵向研究。

Factors influencing bone loss in rheumatoid arthritis: a longitudinal study.

作者信息

Cortet B, Guyot M H, Solau E, Pigny P, Dumoulin F, Flipo R M, Marchandise X, Delcambre B

机构信息

Department of Rheumatology, CHRU Lille, Hôpital R. Salengro, France.

出版信息

Clin Exp Rheumatol. 2000 Nov-Dec;18(6):683-90.

PMID:11138329

Abstract

OBJECTIVES

To assess the occurrence of bone loss in rheumatoid arthritis (RA) and to determine the factors influencing bone loss (particularly the usefulness of bone turnover markers) over an 18-month period.

METHODS

A total of 51 patients were studied, 6 men and 45 females (of whom 35 were menopausal). Their mean age was 56 +/- 10 years and the mean RA duration was 12 +/- 10 years. Twenty-eight (55%) were receiving corticosteroids (10 mg/day for a mean duration of 6 +/- 5 years). Several clinical and biological parameters reflecting disease activity or severity were recorded both at the 0 and 18-month investigations. Bone turnover was assessed at baseline by measuring the serum levels of 4 biological markers. Three of them reflected bone formation, i.e., procollagen type I C-terminal propepeptide (PICP), procollagen type I N-terminal propeptide (PINP) and osteocalcin (OC). The fourth, procollagen type I-C terminal telopeptide (ICTP), reflected bone resorption. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry both at the lumbar spine (LS) and femoral neck (FN) at baseline and 18 months later.

RESULTS

Bone loss occurred both at the LS: 2.1%, [95% CI: 0.8%-3.4%, P < 0.005] and femoral neck: 3.1%, [95% CI: 1.1%-5.1%, P < 0.005]. Bone loss was markedly increased for postmenopausal women at the FN: 5.3% [95% CI: 2.9%-7.6%, P < 0.005]. Bone loss was not statistically significantly different between users and non-users of steroids. Bone loss at the LS was significantly correlated with both osteocalcin (r = 0.51, P < 0.01) and ICTP levels (r = 0.32, P < 0.05). FN bone loss was correlated with the osteocalcin level only (r = 0.34, P < 0.05). Fast losers (bone loss at the LS above the median) had higher OC (P < 0.01) and ESR (P < 0.05) levels at baseline as compared with slow losers (bone loss at the LS below the median).

CONCLUSION

Bone loss occurs in RA particularly at the FN and seems to be influenced by increased bone turnover and high levels of inflammation.

摘要

目的

评估类风湿关节炎（RA）患者骨量丢失的情况，并确定在18个月期间影响骨量丢失的因素（尤其是骨转换标志物的作用）。

方法

共研究了51例患者，其中男性6例，女性45例（其中35例为绝经后女性）。他们的平均年龄为56±10岁，RA的平均病程为12±10年。28例（55%）患者正在接受糖皮质激素治疗（平均剂量为10mg/天，平均疗程为6±5年）。在0个月和18个月的调查中，记录了反映疾病活动或严重程度的几个临床和生物学参数。通过测量4种生物学标志物的血清水平在基线时评估骨转换。其中3种反映骨形成，即I型前胶原C端前肽（PICP）、I型前胶原N端前肽（PINP）和骨钙素（OC）。第4种，I型前胶原C端末端肽（ICTP），反映骨吸收。在基线和18个月后，通过双能X线吸收法测量腰椎（LS）和股骨颈（FN）的骨密度（BMD）。

结果

腰椎骨量丢失为2.1%，[95%可信区间：0.8%-3.4%，P<0.005]；股骨颈骨量丢失为3.1%，[95%可信区间：1.1%-5.1%，P<0.005]。绝经后女性股骨颈骨量丢失明显增加：5.3%[95%可信区间：2.9%-7.6%，P<0.005]。使用和未使用类固醇的患者之间骨量丢失无统计学显著差异。腰椎骨量丢失与骨钙素（r = 0.51，P<0.01）和ICTP水平（r = 0.32，P<0.05）均显著相关。股骨颈骨量丢失仅与骨钙素水平相关（r = 0.34，P<0.05）。快速骨量丢失者（腰椎骨量丢失高于中位数）与缓慢骨量丢失者（腰椎骨量丢失低于中位数）相比，基线时OC（P<0.01）和ESR（P<0.05）水平更高。