类风湿关节炎患者血清骨硬化蛋白与骨密度和血管钙化的关系。

The relationships between serum sclerostin, bone mineral density, and vascular calcification in rheumatoid arthritis.

机构信息

Department of Rheumatology (J.P., P.F.), INSERM Unité 1088 (J.P., R.M., C.R., S.L., P.F., Z.A.M., M.B., S.K.), "Pathophysiological mechanisms and consequences of cardiovascular calcification: role of cardiovascular and bone remodelling," Department of Endocrine and Bone Biology (R.M., M.B., S.K.), and Clinical Research Center (S.L.), Division of Clinical Pharmacology, Amiens University Medical Center, F-80054 Amiens, France; and Department of Nephrology (Z.A.M.), and Amboise Paré University Medical Center, Assistance Publique-Hôpitaux de Paris, F-92100 Boulogne Billancourt, France.

出版信息

J Clin Endocrinol Metab. 2014 Dec;99(12):4740-8. doi: 10.1210/jc.2014-2327.

DOI:10.1210/jc.2014-2327

PMID:25222755

Abstract

CONTEXT

Recent data indicate that the secreted glycoprotein sclerostin may be involved in vascular calcification (VC).

OBJECTIVE

The objective of the study was to establish whether serum sclerostin levels are associated with VC in patients with rheumatoid arthritis (RA).

DESIGN

This was a cross-sectional study.

SETTING

The study was conducted with ambulatory care.

PATIENTS

We compared 75 RA patients with 75 age- and gender-matched control participants.

INTERVENTION

Coronary artery calcification (CAC) and abdominal aortic calcification (AAC) scores were evaluated by computed tomography.

MAIN OUTCOME MEASURE

Serum sclerostin levels (determined with an ELISA) were assessed. A statistical analysis was performed to identify the determinants of serum sclerostin and VC.

RESULTS

AAC and CAC were more prevalent and more severe in patients with RA than in controls. Higher levels of AAC (P = .02) and a higher lumbar bone mineral density (BMD; P = .03) were identified as independent determinants of higher serum sclerostin levels in RA patients, whereas male gender (P = .03), higher lumbar BMD (P < .0001), and low estimated glomerular rate (P < .001) were identified as determinants in controls. In RA patients, a multivariate logistic regression analysis indicated that older age [P < .01, with an odds ratio (OR) per year 1.10] and male gender (P = .02, OR 6.79) were independent determinants of CAC and that older age (P < .001, OR 1.16) were independent determinants of AAC. In controls, the independent determinants were older age (P < .01, OR 1.19), hypertension (P < .01, OR 7.31), and lumbar BMD (P = .03, OR per 30 mg/cm(2) increment of 1.14) for CAC and older age (P = .01, OR 1.11) for AAC.

CONCLUSIONS

Serum sclerostin levels were significantly and independently associated with AAC in RA patients.

摘要

背景

最近的数据表明，分泌型糖蛋白硬化素可能与血管钙化（VC）有关。

目的

本研究旨在确定血清硬化素水平与类风湿关节炎（RA）患者的 VC 是否相关。

设计

这是一项横断面研究。

地点

该研究在门诊进行。

患者

我们比较了 75 例 RA 患者和 75 名年龄和性别匹配的对照参与者。

干预

通过计算机断层扫描评估冠状动脉钙化（CAC）和腹主动脉钙化（AAC）评分。

主要观察指标

评估血清硬化素水平（通过 ELISA 测定）。进行了统计分析以确定血清硬化素和 VC 的决定因素。

结果

与对照组相比，RA 患者的 AAC 和 CAC 更为普遍且更为严重。较高的 AAC 水平（P =.02）和较高的腰椎骨密度（BMD；P =.03）被确定为 RA 患者血清硬化素水平升高的独立决定因素，而男性（P =.03）、较高的腰椎 BMD（P <.0001）和低估计肾小球滤过率（P <.001）被确定为对照组的决定因素。在 RA 患者中，多元逻辑回归分析表明，年龄较大（P <.01，每年的优势比[OR]为 1.10）和男性（P =.02，OR 6.79）是 CAC 的独立决定因素，年龄较大（P <.001，OR 1.16）是 AAC 的独立决定因素。在对照组中，独立决定因素为年龄较大（P <.01，OR 1.19）、高血压（P <.01，OR 7.31）和腰椎 BMD（P =.03，OR 每增加 30mg/cm2 为 1.14）对于 CAC 和年龄较大（P =.01，OR 1.11）对于 AAC。