类风湿关节炎患者大剂量糖皮质激素脉冲治疗期间骨代谢（标志物）的变化。
Changes in (markers of) bone metabolism during high dose corticosteroid pulse treatment in patients with rheumatoid arthritis.
作者信息
Lems W F, Gerrits M I, Jacobs J W, van Vugt R M, van Rijn H J, Bijlsma J W
机构信息
Department of Rheumatology, University Hospital Utrecht, Netherlands.
出版信息
Ann Rheum Dis. 1996 May;55(5):288-93. doi: 10.1136/ard.55.5.288.
OBJECTIVE
To examine the effect of high dose corticosteroid pulse treatment (three times 200 mg dexamethasone intravenously in eight days) on calcium and bone metabolism in 17 consecutive patients with active rheumatoid arthritis (RA).
METHODS
Bone formation was quantified by measurement of serum alkaline phosphatase, osteocalcin, and carboxyterminal propeptide of type I procollagen (pro-I-CPP) concentrations. Bone resorption was measured by urinary excretion of calcium, hydroxyproline, (free and total) deoxypyridinoline (Dpyr), (free and total) pyridinoline (Pyr), and serum concentrations of the carboxyterminal cross linked telopeptide of type I collagen (I-CTP). Disease activity of RA was measured by erythrocyte sedimentation rate, C reactive protein, and Ritchie and Thompson joint scores.
RESULTS
Disease activity was initially high, and decreased during corticosteroid pulse treatment and the following five weeks. Osteocalcin, alkaline phosphatase, and pro-I-CPP concentrations were initially within normal limits, while I-CTP, Dpyr, and Pyr were increased. Osteocalcin and pro-I-CPP concentrations decreased (p < 0.01) during corticosteroid pulse treatment, but rapidly returned to baseline after the treatment. No changes were observed in alkaline phosphatase and urinary excretion of calcium and hydroxyproline. Bone resorption measured by serum I-CTP and urinary excretion of Pyr and Dpyr was unchanged or decreased (p < 0.05-0.01), depending on the time of measurement and the parameter measured.
CONCLUSIONS
In these patients with active RA, bone resorption was increased, while bone formation was within normal limits. During high dose corticosteroid pulse treatment, bone formation was only transiently decreased, while markers of bone resorption were unchanged or decreased. Because corticosteroid pulse treatment has only a short term negative effect on bone formation, and because it probably reduces bone resorption, at least partly as a result of the decreased disease activity, the effect of corticosteroid pulse treatment on bone may be assumed to be relatively mild.
目的
研究大剂量皮质类固醇脉冲治疗（8天内静脉注射3次200mg地塞米松）对17例连续的活动性类风湿关节炎（RA）患者钙和骨代谢的影响。
方法
通过测量血清碱性磷酸酶、骨钙素和I型前胶原羧基末端前肽（pro-I-CPP）浓度来量化骨形成。通过尿钙、羟脯氨酸、（游离和总）脱氧吡啶啉（Dpyr）、（游离和总）吡啶啉（Pyr）排泄量以及I型胶原羧基末端交联端肽（I-CTP）血清浓度来测量骨吸收。通过红细胞沉降率、C反应蛋白以及Ritchie和Thompson关节评分来测量RA的疾病活动度。
结果
疾病活动度最初较高，在皮质类固醇脉冲治疗期间及随后的五周内降低。骨钙素、碱性磷酸酶和pro-I-CPP浓度最初在正常范围内，而I-CTP、Dpyr和Pyr升高。皮质类固醇脉冲治疗期间骨钙素和pro-I-CPP浓度降低（p<0.01），但治疗后迅速恢复至基线。碱性磷酸酶以及尿钙和羟脯氨酸排泄量未观察到变化。根据测量时间和测量参数，通过血清I-CTP以及尿Pyr和Dpyr排泄量测量的骨吸收未改变或降低（p<0.05-0.01）。
结论
在这些活动性RA患者中，骨吸收增加，而骨形成在正常范围内。在大剂量皮质类固醇脉冲治疗期间，骨形成仅短暂降低，而骨吸收标志物未改变或降低。由于皮质类固醇脉冲治疗对骨形成仅具有短期负面影响，并且由于它可能至少部分由于疾病活动度降低而减少骨吸收，因此可以认为皮质类固醇脉冲治疗对骨的影响相对较轻。
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