Bogaczewicz Jaroslaw, Karczmarewicz Elzbieta, Pludowski Pawel, Zabek Jakub, Kowalski Jan, Lukaszkiewicz Jacek, Wozniacka Anna
Departamento de Dermatologia e Venereologia, Medical University of Lodz, Lodz, Polônia.
Departamento de Bioquímica, Radioimunologia e Medicina Experimental, The Children's Memorial Health Institute, Varsóvia, Polônia.
Rev Bras Reumatol. 2015 Mar-Apr;55(2):133-9. doi: 10.1016/j.rbr.2014.10.004. Epub 2014 Nov 21.
To investigate the feasibility of bone turnover markers (BTMs) for the assessment of bone metabolism in patients with systemic lupus erythematosus (SLE), according to the guidelines of the International Osteoporosis Foundation and the International Federation of Clinical Chemistry and Laboratory Medicine.
The study included 43 female SLE patients. Serum procollagen type I N propeptide (PINP), C-terminal telopeptide of type I collagen (CTX), osteocalcin, PTH, 25(OH)D, anti-cardiolipin, anti-dsDNA, and anti-nucleosome levels were measured.
PINP and CTX levels were elevated in SLE patients aged > 45 in comparison to those aged < 45, although with borderline significance (p = 0.05, respectively). Correlations were found between BTMs: the strongest being between PINP and osteocalcin (τ = 0.69, p < 0.05). PINP and osteocalcin were found to be associated with PTH (τ = 0.3, τ = 0.29, respectively, p < 0.05). Age correlated with PINP (τ = 0.23, p < 0.05). Elevated PINP was found more frequently than elevated osteocalcin or CTX, both in patients aged < 45 (p = 0.001) and > 45 (p < 0.001). No significant difference in PINP, osteocalcin or CTX levels was found with respect to season, neither in the entire SLE group, nor in the under-45 or over-45 groups. Previous glucocorticoid treatment was not associated with difference in BTMs.
Increased BTMs in SLE appear to predominantly reflect the pattern of bone remodeling related to age. Increased PINP is expected to be the most frequent outcome among BTMs. Better diagnoses of bone disturbances with BTMs performed in accordance with international reference standards need to be included in the approach to SLE patients, in addition to bone mineral density assessment.
根据国际骨质疏松基金会以及国际临床化学与检验医学联合会的指南，探讨骨转换标志物（BTMs）用于评估系统性红斑狼疮（SLE）患者骨代谢的可行性。
该研究纳入了43名女性SLE患者。检测血清I型前胶原N端前肽（PINP）、I型胶原C端肽（CTX）、骨钙素、甲状旁腺激素（PTH）、25羟维生素D[25(OH)D]、抗心磷脂、抗双链DNA及抗核小体水平。
年龄>45岁的SLE患者的PINP和CTX水平高于年龄<45岁的患者，不过差异接近临界值（p值分别为0.05）。发现BTMs之间存在相关性：最强的是PINP与骨钙素之间的相关性（τ = 0.69，p < 0.05）。发现PINP和骨钙素与PTH相关（τ值分别为0.3、0.29，p < 0.05）。年龄与PINP相关（τ = 0.23，p < 0.05）。在年龄<45岁（p = 0.001）和>45岁（p < 0.001）的患者中，PINP升高比骨钙素或CTX升高更常见。无论是在整个SLE组，还是在45岁以下或45岁以上组中，PINP、骨钙素或CTX水平在季节方面均无显著差异。既往糖皮质激素治疗与BTMs差异无关。
SLE患者中BTMs升高似乎主要反映了与年龄相关的骨重塑模式。PINP升高预计是BTMs中最常见的结果。除骨密度评估外，对SLE患者的诊疗方法还应包括按照国际参考标准使用BTMs更好地诊断骨紊乱情况。
