维生素D状态及骨转换标志物在类风湿关节炎合并骨质疏松症中的诊断价值

Diagnostic Value of Vitamin D Status and Bone Turnover Markers in Rheumatoid Arthritis Complicated by Osteoporosis.

作者信息

Tan Li-Ming, Long Ting-Ting, Guan Xiao-Lin, Wu Si-Fan, Zheng Wei, Fu Hui-Ying, Wang Qiao-Hua, Meng Yi-Mei, Wu Yang, Zeng Ting-Ting, Tian Yong-Jian, Yu Jian-Lin, Chen Juan-Juan, Li Hua, Cao Li-Ping

机构信息

Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China

School of Public Health, Nanchang University, Nanchang, Jiangxi, China.

出版信息

Ann Clin Lab Sci. 2018 Mar;48(2):197-204.

PMID:29678847

Abstract

OBJECTIVE

To research the diagnostic performance of clinical potential bone turnover indexes in rheumatoid arthritis (RA) complicated with osteoporosis (OP).

METHODS

This study involved 87 RA patients, 48 with OP, and 39 without OP, and 204 non-RA control patients, including those with systemic lupus erythematosus, ankylosing spondylitis, primary Sjogren's syndrome, systemic sclerosis, and healthy patients. The levels of 25-hydroxyvitamin D [25(OH)D], β-crosslaps (β-CROSSL), parathyroid hormone (PTH) were measured by electrochemiluminescence (ECLIA), and the level of bone alkaline phosphatase (BALP) was measured by lectin affinity method.

RESULTS

The serum concentration of 25(OH)D in the RA with OP group was significantly lower than the control group (<0.01), while the levels of β-CROSSL, BALP in the RA with OP group considerably exceeded those found in the control group (<0.01). The levels of β-CROSSL and PTH were significantly higher in RA patients with OP than without OP (<0.01), while the level of 25(OH)D was statistically lower than without OP (<0.01). An unconditional logistical regression analysis proved an association with low 25(OH)D and elevated β-CROSSL in RA with OP, with 25(OH)D demonstrating greatest diagnostic potential according to the ROC curve.

CONCLUSION

The significantly reduced levels of 25(OH)D and excessive β-CROSSL may indicate a high risk of the secondary osteoporosis in RA patients.

摘要

目的

研究临床潜在骨转换指标在类风湿关节炎（RA）合并骨质疏松（OP）中的诊断效能。

方法

本研究纳入87例RA患者，其中48例合并OP，39例未合并OP，以及204例非RA对照患者，包括系统性红斑狼疮、强直性脊柱炎、原发性干燥综合征、系统性硬化症患者及健康者。采用电化学发光免疫分析法（ECLIA）检测25-羟基维生素D[25(OH)D]、β-交联羧基末端肽（β-CROSSL）、甲状旁腺激素（PTH）水平，采用凝集素亲和法检测骨碱性磷酸酶（BALP）水平。

结果

RA合并OP组血清25(OH)D浓度显著低于对照组（<0.01），而RA合并OP组β-CROSSL、BALP水平显著高于对照组（<0.01）。RA合并OP患者的β-CROSSL和PTH水平显著高于未合并OP者（<0.01），而25(OH)D水平低于未合并OP者（<0.01）。无条件logistic回归分析证实，RA合并OP患者中低25(OH)D水平与升高的β-CROSSL有关，根据ROC曲线，25(OH)D显示出最大的诊断潜力。