Li Haibo, Li Qiuxia, Chen Xi, Ji Chen, Gu Jieruo
From Sun Yat-sen University, Guangzhou; Department of Rheumatology, General Hospital of Ningxia Medical University, Yinchuan, China.H. Li, PhD Candidate, Sun Yat-sen University, and Department of Rheumatology, General Hospital of Ningxia Medical University; Q. Li, PhD; X. Chen, Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University; C. Ji, Department of Rheumatology, General Hospital of Ningxia Medical University; J. Gu, Third Affiliated Hospital of Sun Yat-sen University.
J Rheumatol. 2015 Aug;42(8):1413-7. doi: 10.3899/jrheum.150019. Epub 2015 Jun 15.
To evaluate the effect of anti-tumor necrosis factor (TNF) therapy on bone mineral density (BMD) in patients with active ankylosing spondylitis (AS) with low BMD.
Eighty-nine patients with active AS with low BMD were randomly divided into either a study group or a control group. The study group received etanercept (50 mg/week) or adalimumab (40 mg/2 week) subcutaneously for 1 year. BMD of lumbar spine and femoral neck was measured by dual energy X-ray absorptiometry, and bone turnover markers serum C telopeptide of type-I collagen (sCTX) and serum procollagen type-I N propeptide (PINP) were detected by ELISA at baseline and at end of study.
After 1 year, compared with baseline, there was a significant increase in spine and femoral neck BMD by a mean ± SD of 14.9% ± 15.6% (p < 0.0001) and 4.7% ± 7.9% (p < 0.0001) in the study group. In the control group, there was a significant decrease in spine and femoral neck BMD by a mean ± SD of -8.6% ± 9.7% (p < 0.0001) and -9.8% ± 11.5% (p < 0.0001). Compared with baseline, sCTX was significantly decreased in the study group (-40% at 1 yr, p < 0.0001), but bone-specific alkaline phosphatase and PINP increased (45.6%, p < 0.0001 and 30.8%, p < 0.0001, respectively).
In patients with active AS with low BMD, the spine and femoral neck BMD increased after anti-TNF therapy for 1 year, and it was accompanied by a significant decrease in bone resorption markers and an increase in bone formation markers.
评估抗肿瘤坏死因子（TNF）治疗对骨密度（BMD）低的活动性强直性脊柱炎（AS）患者骨密度的影响。
89例骨密度低的活动性AS患者被随机分为研究组或对照组。研究组皮下注射依那西普（50mg/周）或阿达木单抗（40mg/每2周），持续1年。采用双能X线吸收法测量腰椎和股骨颈的骨密度，并在基线和研究结束时通过酶联免疫吸附测定法（ELISA）检测骨转换标志物血清I型胶原C末端肽（sCTX）和血清I型前胶原N端前肽（PINP）。
1年后，与基线相比，研究组脊柱和股骨颈骨密度显著增加，平均±标准差分别为14.9%±15.6%（p<0.0001）和4.7%±7.9%（p<0.0001）。对照组脊柱和股骨颈骨密度显著降低，平均±标准差分别为-8.6%±9.7%（p<0.0001）和-9.8%±11.5%（p<0.0001）。与基线相比，研究组sCTX显著降低（1年时降低40%，p<0.0001），但骨特异性碱性磷酸酶和PINP升高（分别为45.6%，p<0.0001和30.8%，p<0.0001）。
对于骨密度低的活动性AS患者，抗TNF治疗1年后脊柱和股骨颈骨密度增加，同时骨吸收标志物显著降低，骨形成标志物增加。
