Hartl Agnes, Sieper Joachim, Syrbe Uta, Listing Joachim, Hermann Kay-Geert, Rudwaleit Martin, Poddubnyy Denis
Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
German Rheumatism Research Centre, Charitéplatz 1, 10117, Berlin, Germany.
Arthritis Res Ther. 2017 Jun 15;19(1):140. doi: 10.1186/s13075-017-1350-9.
Previous research indicates a role of adipokines in inflammation and osteogenesis. Hence adipokines might also have a pathophysiological role in inflammation and new bone formation in patients with ankylosing spondylitis (AS). The aim of this study was to investigate the role of adipokine serum levels as predictors of radiographic spinal progression in patients with AS.
A total of 120 patients with definite AS who completed a 2-year follow up in the ENRADAS trial were included in the current study. Radiographic spinal progression was defined as: (1) worsening of the modified Stoke Ankylosing Spondylitis spine (mSASSS) score by ≥2 points and/or (2) new syndesmophyte formation or progression of existing syndesmophytes after 2 years. Serum levels of adipokines (adiponectin (APN) and its high molecular weight form (HMW-APN), chemerin, leptin, lipocalin-2, omentin, resistin, visfatin) were measured using enzyme-linked immunosorbent assays.
There was a significant association between radiographic spinal progression and both leptin and HMW-APN. Baseline serum levels of both adipokines were lower in patients who showed radiographic spinal progression after 2 years. This association was especially evident in men; they had generally lower leptin and HMW-APN serum levels as compared to women. The inverse association between adipokines and radiographic spinal progression was confirmed in the logistic regression analysis: the odds ratios (OR) for the outcome "no mSASSS progression ≥2 points" were 1.16 (95% CI 1.03 to 1.29) and 1.17 (95% CI 0.99 to 1.38), for leptin and HMW-APN, respectively; for "no syndesmophyte formation/progression" the respective OR were 1.29 (95% CI 1.11 to 1.50) and 1.18 (95% CI 0.98 to 1.42), adjusted for the presence of syndesmophytes at baseline, C-reactive protein at baseline, sex, body mass index (BMI), non-steroidal anti-inflammatory drugs intake score over 2 years, and smoking status at baseline.
Serum leptin and HMW-APN predict protection from spinal radiographic progression in patients with AS. Women generally have higher leptin and HMW-APN serum levels that might explain why they have less structural damage in the spine as compared to male patients with AS.
EudraCT: 2007-007637-39. ClinicalTrials.gov, NCT00715091 . Registered on 14 July 2008.
先前的研究表明脂肪因子在炎症和成骨过程中发挥作用。因此，脂肪因子在强直性脊柱炎（AS）患者的炎症和新骨形成中可能也具有病理生理作用。本研究的目的是探讨脂肪因子血清水平作为AS患者脊柱影像学进展预测指标的作用。
本研究纳入了120例在ENRADAS试验中完成2年随访的确诊AS患者。脊柱影像学进展定义为：（1）改良斯托克强直性脊柱炎脊柱（mSASSS）评分恶化≥2分和/或（2）2年后出现新的韧带骨赘形成或现有韧带骨赘进展。采用酶联免疫吸附测定法检测脂肪因子（脂联素（APN）及其高分子量形式（HMW-APN）、趋化素、瘦素、脂质运载蛋白-2、网膜素、抵抗素、内脂素）的血清水平。
脊柱影像学进展与瘦素和HMW-APN均显著相关。2年后出现脊柱影像学进展的患者，这两种脂肪因子的基线血清水平较低。这种关联在男性中尤为明显；与女性相比，他们的瘦素和HMW-APN血清水平普遍较低。逻辑回归分析证实了脂肪因子与脊柱影像学进展之间的负相关：对于“mSASSS进展≥2分”这一结局，瘦素和HMW-APN的比值比（OR）分别为1.16（95%CI 1.03至1.29）和1.17（95%CI 0.99至1.38）；对于“无韧带骨赘形成/进展”，相应的OR分别为1.29（95%CI 1.11至1.50）和1.18（95%CI 0.98至1.42），对基线时韧带骨赘的存在情况、基线时的C反应蛋白、性别、体重指数（BMI）、2年期间非甾体抗炎药摄入评分以及基线时的吸烟状况进行了校正。
血清瘦素和HMW-APN可预测AS患者脊柱影像学进展的情况。女性的瘦素和HMW-APN血清水平通常较高，这可能解释了与男性AS患者相比，她们脊柱结构损伤较少的原因。
欧洲临床试验数据库（EudraCT）：2007-007637-39。美国国立医学图书馆临床试验注册库（ClinicalTrials.gov），NCT00715091。于2008年7月14日注册。
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