脊柱结核与骨量减低相关研究

背景：脊柱结核是骨结核中最常见的类型。近年来,老年性脊柱结核的发病率逐渐升高,甚至伴发骨质疏松。而结核病是否会引起患者骨量减低的研究相对较少。目的：通过对脊柱结核患者和健康正常人群的骨密度及骨生化指标的分析比较,探讨脊柱结核与骨量减低的相关性。方法：本研究纳入110例脊柱结核患者和98例健康正常人。双光能X线骨密度仪测定正位腰椎（L3-L4）及左股骨颈、股骨大转子、Ward角、整体髋的骨密度;电化学发光免疫分析法检测骨碱性磷酸酶（BAP）、骨钙素（BGP）、I型胶原羧基端前肽（CTX）。结果：两组间性别、年龄差异无统计学意义（P〉0．05）。脊柱结核组腰椎及左侧股骨颈、股骨大转子、Ward三角、整体髋骨密度低于对照组（P〈0．05）,且脊柱结核组骨量减少、骨质疏松发生率较对照组显著增高（P〈0．05）;在骨生化指标方面,脊柱结核组CTX水平高于对照组（P〈0．05）。脊柱结核患者腰椎及左侧股骨颈、股骨大转子、Ward三角、整体髋骨密度与CTX水平呈负相关（P〈O．05）。结论：脊柱结核可能会导致骨量减少,其发生与破骨细胞活性增强,促进骨吸收有关;骨质疏松预防性治疗可减少脊柱结核术后并发症的发生。     

强直性脊柱炎患者血清TNF-a、BGP和CTX水平与骨密度的关系

目的探讨强直性脊柱炎(AS)患者骨质疏松(OP)的发病机制。方法分别测定36例男性AS患者血清肿瘤坏死因子-a(TNF-a)、骨钙素(BGP)I、-型胶原C末端肽(CTX)水平及腰椎和股骨颈的骨密度(BMD)值,并与20例健康者对照。结果AS早期腰椎和股骨颈BMD均低于对照组,晚期股骨颈BMD更低于对照组。AS血清TNF-a、CTX水平较对照组显著增高(P<0.01;P<0.05),而血清BGP水平较对照组无显著差差异(P>0.05)。AS患者中OP组TNF-a、CTX水平较NOP组显著增高(P<0.01;P<0.05),OP组中血清TNF-a与CTX呈正相关,与股骨颈密度呈负相关;与BGP无明显相关性。结论AS患者主要是由于骨吸收增加而导致骨质疏松的发生。血清TNF-α水平的增高可促进骨吸收加强,是AS骨质疏松的重要原因之一。降低血清TNF-a水平,对AS患者骨质疏松的防治可能有积极的意义。     

强直性脊柱炎患者骨密度异常的危险因素分析

目的:探索强直性脊柱炎(ankylosing spondylitis,AS)患者发生骨密度异常的危险因素。方法:调查选取2018年5月～2019年5月来本院就诊的AS患者年龄、病程、血沉(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)等炎症指标和枕墙距、胸廓活动度等体格检查情况。选取同期健康人作为对照组。使用双能X线骨密度吸收仪测定AS患者及对照组股骨颈、大转子、腰椎及全髋关节骨密度情况,并采用独立样本t检验进行组间差异性比较。同时采用Pearson相关性分析,探索AS患者各部位骨密度异常情况与病程、年龄、炎症指标等的相关性,采用多元线性回归分析AS骨密度异常的危险因素。结果:本次研究共纳入23例AS男性患者,平均年龄36.6±5.9岁,20名健康成年男性对照,平均年龄38.9±4.0岁(P0.05)。病例组中位病程5(3,7)年。病例组股骨颈(0.86±0.17)、大转子(0.85±0.12)、腰椎(0.90±0.10)、全髋关节(0.88±0.16)骨密度均低于对照组(0.98±0.21、0.94±0.15、1.16±0.14及0.99±0.19),差异有统计学意义(P0.05)。病例组患者股骨颈、全髋关节骨量异常与病程、年龄、炎症指标、枕墙距和指地距呈负相关,与胸廓活动度和脊柱活动度呈正相关(P0.05)。大转子骨密度异常与年龄、ESR、CRO、枕墙距呈负相关,与胸廓活动度和脊柱活动度呈正相关(P0.05)。单因素分析发现病程、ESR、CRP、指地距、胸廓活动度与AS骨质异常相关(P0.05),多元线性回归分析结果表明病程(b=1.33,P=0.01)、ESR(b=0.75,P=0.04)为AS骨密度异常的独立危险因素。结论:AS患者股骨颈、大转子、腰椎及全髋关节骨密度均低于同龄健康人,股骨颈、全髋关节骨量异常与病程、年龄、炎症指标、枕墙距和指地距、胸廓活动度和脊柱活动度有关联,而病程、ESR为AS骨密度异常的独立危险因素。     

骨灵汤联合rh TNFR:Fc对强直性脊柱炎骨代谢、影像学及血清OPG/RANKL的影响

目的 评价骨灵汤联合重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(rh TNFR:Fc)治疗强直性脊柱炎(AS)前后骨代谢标志物、影像学及血清OPG/RANKL的变化.方法 将52例AS患者随机分为两组:治疗1组(26例)以骨灵汤加rh TNFR:Fc治疗;治疗2组(26例)采用rh TNFR:Fc治疗,疗程均为24周.观察指标包括治疗前后患者Bath AS疾病活动性指数(BASDAI)和急性期反应物水平;患者骨钙素(OC)、C-端肽(CTX)、NF-κB受体活化因子配体(RANKL)及骨保护素(OPG)的水平;并对治疗前后的骶髂关节、髋关节X线影像进行Bath AS放射学评分(BASRI).结果 两组患者在治疗24周后,活动性指数较治疗前均有明显改善(P＜0.05),但两组之间同期比较差异无显著性(P＞0.05).骨代谢标志物:在治疗24周后两组与各自治疗前比较,血清OC均显著增加,CTX均显著下降(P＜0.05);治疗后两组间比较,治疗1组比治疗2组血清OC显著增加,CTX显著下降(P＜0.05).影像 BASRI评分:两组患者的骶髂关节评分(BASRI-SIJ)和髋关节评分(BASRI-h)在两组间及自身治疗前后比较均无显著差异(P＞0.05).血清OPG、RANKL水平:两组在治疗24周后与各自治疗前比较血清OPG均显著升高(P＜0.05),RANKL均显著下降(P＜0.05),OPG/RANKL比值均显著升高(P＜0.05);治疗后两组间比较,治疗1组比治疗2组OPG显著升高(P＜0.05),RANKL显著下降(P＜0.05),OPG/RANKL比值显著升高(P＜0.05).结论 rh TNFR:Fc 治疗可显著改善AS疾病的活动性,调节骨代谢及OPG系统,且阻止骶髂关节及髋关节的骨破坏;骨灵汤联合rh TNFR:Fc治疗AS,对骨代谢及血清OPG/RANKL水平影响意义更显著(P＜0.05).提示骨灵汤、rh TNFR:Fc有可能通过对OPG系统的调节作用进一步调节骨代谢,阻止AS患者出现的骨质破坏,故可作为治疗AS的较佳方案.     

阿达木单抗对强直性脊柱炎患者骨代谢标志物的影响

目的观察阿达木单抗对强直性脊柱炎(AS)患者骨代谢标志物的影响。方法随机选取2014年1月至2017年12月长海医院风湿免疫科收治的活动性强直性脊柱炎患者42例,同时选取42例正常人作为对照组,所有AS患者均接受40 mg阿达木单抗隔周皮下给药治疗24周。采用DXA骨密度仪检测腰椎和髋部骨密度,电化学发光法检测血清骨代谢指标β-胶原降解产物(β-CTX)、总Ⅰ型胶原氨基端延长肽(P1NP)、骨钙素N端中分子片段(N-MID)、25羟基维生素D、甲状旁腺素(PTH),收集AS患者相关临床及实验室检测指标,观察AS患者骨质疏松发生情况,比较AS组与正常对照组之间血清骨代谢指标,以及AS患者经阿达木单抗治疗后病情活动度和血清骨代谢指标的变化。结果 42名活动性AS患者中骨质疏松发生率为13. 6%,骨量减少的发生率为25. 8%,骨量正常者占60. 6%。与正常对照组比较,AS患者骨代谢标志物β-CTX、P1NP、NMID、PTH水平明显升高(P0. 01),25羟基维生素D水平明显下降(P0. 01)。AS患者经阿达木单抗治疗24周后临床症状及实验室指标均得到明显改善,骨代谢标志物β-CTX、P1NP、N-MID、PTH水平明显下降(P0. 01),25羟基维生素D水平明显升高(P0. 01),血钙、血磷水平无明显变化。结论 AS患者存在骨代谢紊乱,骨形成和骨破坏均活跃;阿达木单抗治疗不仅可改善AS疾病活动度,同时能改善AS患者骨代谢。     

活性维生素D对骨量减少的强直性脊柱炎患者骨代谢指标及病情的影响

目的探讨补充活性维生素D对于骨量减少的强直性脊柱炎(AS)患者骨代谢标志物、骨密度及炎性指标的影响。方法选取骨量减少的AS患者60例为研究对象,同期健康体检者20例作为健康组,比较两组受试者血清骨特异性碱性磷酸酶(BALP)、抗酒石酸酸性磷酸酶异构体-5b(TRACP-5b)、25-(OH)D3的水平。将上述AS患者随机分为治疗组和对照组,每组30例,对照组口服美洛昔康、柳氮磺吡啶、碳酸钙,治疗组在此基础上加用骨化三醇口服。比较2组治疗前后BALP、TRACP-5b、25-(OH)D3,骨密度(BMD)以及红细胞沉降率(ESR)、C反应蛋白(CRP)等指标的变化水平。结果 AS组BALP、TRACP-5b高于健康组,25-(OH)D3低于健康组(P0.05)。治疗组和对照组治疗后血清BALP、25-(OH)D3水平均有升高(P0.05),TRACP-5b水平均有下降(P0.05);治疗组BALP及25-(OH)D3治疗前后差值高于对照组(P0.05)。6个月后治疗组复查腰椎、大转子、转子间BMD较对照组均有不同程度的提升(P0.05),5例骨量恢复正常;对照组6个月后BMD变化不明显;治疗组治疗前后腰椎、大转子、转子间BMD变化差值均高于对照组(P0.05);治疗组与对照组ESR、CRP及BASDAI评分较前均有所降低(P0.05),其中治疗组ESR下降水平较对照组差异具有统计学意义(P0.05)。结论活性维生素D可以改善骨量减少的强直性脊柱炎患者的骨代谢指标并降低疾病活动度。     

强直性脊柱炎患者骨密度及骨代谢标志物的变化

目的观察强直性脊柱炎(AS)患者骨密度(BMD)及骨代谢标志物的变化。方法 AS组:2013年1月-2015年2月,52例,男40例、女12例,年龄(32.33±13.51)岁;健康对照组:50例,男38例、女12例,年龄(31.52±11.87)岁。检测双股骨颈、腰椎1-4BMD与T值;血清骨钙素(BGP)、I型原胶原氨基端前肽(PINP)、I型胶原C-末端肽(CTX);AS组检测C-反应蛋白(CRP)、血沉(ESR),计算病情活动指数(BASDAI)及功能指数(BASFI)。采用t检验与相关分析。结果 (1)AS组男、女性双股骨颈BMD(0.943±0.163,0.940±0.148)低于对照组(1.179±0.142,1.176±0.141);腰椎1-4BMD(1.057±0.179,1.069±0.187)低于对照组(1.199±0.121,1.202±0.166);(2)AS组双股骨颈、腰椎1-4骨质疏松及骨量减少分别是57.69%和61.53%;(3)AS组双股骨颈、腰椎1-4BMD与BASDAI呈负相关性(r=-0.426、-0.478)(P0.05);(4)AS组男、女性BGP含量(13.47±4.36、13.85±3.75)低于对照组(21.57±3.18、20.77±4.19)(P0.05),PINP含量(24.47±3.53、23.66±4.73)低于对照组(32.25±4.33、31.17±3.20)(P0.05),CTX含量(0.80±0.13、0.74±0.17)高于对照组(0.37±0.10、0.37±0.13)(P0.05);(5)AS组BGP与双股骨颈、腰椎1-4BMD呈正相关性(r=0.475、0.431)(P0.05),CTX呈负相关性(r=-0.516、-0.466)(P0.05)。结论 AS患者存在BMD降低,BGP、PINP含量减少,CTX增加,导致骨质疏松,应采取防治措施。     

中老年骨量异常人群血清骨代谢生化指标与FRAX骨折风险相关性分析

目的研究中老年骨量减少或骨质疏松人群的血清骨代谢生化指标,探讨血清骨代谢生化标志物对受试者骨折风险的影响。方法研究84例中老年骨量减少或骨质疏松受试者资料,记录相关人口统计学数据,检测受试者骨密度和血清骨代谢生化指标,使用骨折风险评估工具(FRAX)计算个体10年骨折发生的概率。根据FRAX计算结果,将受试者分为骨质疏松骨折高风险组和低风险组,t检验比较二组年龄、性别、体质量指数、骨质疏松比例、股骨颈、髋部和腰椎的骨密度以及血清骨代谢生化指标的差异; Pearson或Spearman相关分析了解各临床指标与FRAX骨折概率的相关性; Logistic回归分析影响FRAX骨折风险的因素。结果骨折高风险组的年龄、骨质疏松患者比例明显高于低风险组,股骨颈和髋部骨密度以及血清25-羟基维生素D_3[25-Hydroxyvitamin D_3,25(OH) D_3]水平明显低于低风险组,差异有统计学意义(P0.05),其中高风险组和低风险组25(OH) D_3水平的中位数和(最小值～最大值)分别为20.61(12.19～43.24)和29.97 (11.91～72.70);年龄与两个骨折概率均呈正相关(P0.05),股骨颈和髋部骨密度以及血清25(OH) D_3水平与两个骨折概率均呈负相关(P0.05),其中25(OH) D_3水平与两个骨折概率的相关系数r值均为-0.51; Logistic回归分析显示,股骨颈骨密度和血清25(OH) D_3是FRAX骨折风险的重要相关因素。结论血清25(OH) D_3可能是预测中老年骨量减少或骨质疏松人群脆性骨折风险较敏感的骨代谢标志物。     

强直性脊柱炎骨代谢的研究

目的 研究强直性脊柱炎(AS)患者的骨代谢特征,以及强直性脊柱炎临床相关因素和骨代谢的关系.方法 分别测定及比较AS患者和健康对照组TRAP、BGP、OPG.用BASDAI方法评价AS病情活动性,分析AS患者炎症指标(ESR、CRP、BASDAI)、性别、发病年龄、病程、HLA-B27与骨代谢指标(TRAP、BGP、OPG)的关系.结果 AS患者中OPG,TRAP水平明显高于健康对照组(P<0.05),AS组中TRAP随ESR、CRP、BASDAI、性别、病程的变化而变化,多元分析结果OR值最大的是BASDAI.结论 AS患者骨代谢指标的研究表明,AS患者骨代谢表现为骨吸收增加.AS患者骨吸收受ESR、CRP、BASDAI、性别、病程的影响,影响最大的是BASDAI.     

骨疏宁片联合阿托伐他汀对2型糖尿病合并绝经后骨质疏松症患者骨密度及骨代谢的影响

目的研究骨疏宁片联合阿托伐他汀对2型糖尿病合并绝经后骨质疏松症患者骨密度及骨代谢的影响。方法 124例2型糖尿病合并骨质疏松症妇女随机分为治疗组和对照组,治疗组进行骨疏宁片联合阿托伐他汀治疗,对照组单纯予以阿托伐他汀治疗。治疗前及治疗后12个月分别检测两组受试者腰椎1~4和左侧股骨颈骨密度、VAS疼痛评分以及骨代谢指标。结果治疗前,各组受试者骨密度、VAS疼痛评分以及骨代谢指标比较无统计学意义(P0.05)。治疗6个月及12个月,两组患者VAS评分不同程度降低,其中以治疗组骨痛的治疗效果要明显优于对照组(P0.05)。治疗12个月两组L1~4椎体、股骨颈的BMD明显升高(P0.05),而治疗组明显高于对照组(P0.05)。治疗12个月,两组血清I型胶原N端前肽(type 1 collagen N terminal peptide,P1NP)的水平明显升高,而I型胶原羧基末端肽(type I collagen carboxy-terminal peptide,CTX)水平明显下降,和对照组比较,治疗组血清P1NP及CTX水平改变更为明显(P0.05)。结论骨疏宁片联合阿托伐他汀可以显著提高2型糖尿病合并骨质疏松症女性骨密度及降低VAS评分,且能改善2型糖尿病合并绝经后骨质疏松症患者骨代谢异常,值得临床推广。     

Prevalence and Risk Factors of Low Bone Mineral Density in Juvenile Onset Ankylosing Spondylitis

The objective of this study is to assess the prevalence and risk in patients with juvenile onset ankylosing spondylitis (JoAS) complicated with low bone mineral density (BMD). A total of 112 children and adolescents with JoAS were enrolled in the study. Bone mass was measured from the lumbar spine and the left proximal femur using dual-energy X-ray absorptiometry. According to the 2007 International Society of Clinical Densitometry definitions, a Z score of less than ?2 was termed as “low BMD.” Stepwise regression analysis was used to investigate associations between low BMD and disease-related factors including gender, age, weight, height, body mass index, disease duration, HLA-B27 antigen, grades of sacroiliitis, Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), patient global assessment (PGA), spine pain, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Low BMD was found in 18 (16.1 %) cases in at least one of the two measured regions. Lumbar spine BMD had negative correlations with BASDAI, BASFI, spine pain, ESR, and CRP (P < 0.05). Hip BMD significantly negatively correlated with BASDAI and PGA (P < 0.05). In conclusion, patients with JoAS are likely to develop low BMD, which may be related to high disease activity.     

Serum tissue factor levels correlate with inflammation in ankylosing spondylitis

BACKGROUND: Tissue factor, the main initiator of blood coagulation, is released into the bloodstream when vessel damage occurs. Vessel damage may occur in ankylosing spondylitis (AS). OBJECTIVE: To measure tissue factor levels in patients with AS and to look for correlations between tissue factor levels and established clinical and laboratory markers for disease activity. METHODS: We compared patients who met modified New York criteria for AS to healthy untreated controls. Serum tissue factor was assayed using an ELISA. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Global Score (BAS-G) were recorded, as well as the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and IgA level. ANOVA and t-tests were performed. P values<0.05 were considered significant. RESULTS: We included 28 patients with AS (mean age, 42 years; and mean disease duration, 14 years), who had never received immunomodulating or vascular medications, and 22 same-age healthy controls. In the patients, tissue factor levels were significantly higher (32.6+/-33.6 vs. 9.5+/-11.5 pg/ml, P=0.003); they correlated with the ESR (P=0.018), CRP (P<0.0001), and IgA (P=0.023), but not with the clinical variables (BASDAI, BASFI, and BAS-G; P>0.05). CONCLUSION: In this preliminary study in patients with AS, tissue factor levels were high and correlated with laboratory tests for inflammation. Tissue factor elevation may be a cause or a consequence of AS inflammation that promotes the occurrence of vascular events.     

Relationship between periodontal status and disease activity in patients with ankylosing spondylitis

ObjectivesAnkylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the spine and sacroiliac joints, characterized by enthesitis. Recent studies have investigated the relationship between AS and periodontitis. The aim of this study was to evaluate the periodontal status of patients with AS and to determine the factors affecting this.Material and methodsThe study included 200 AS patients, of which 129 were taking anti-tumour necrosis factor (TNF) drugs and 71 were taking non-steroid anti-inflammatory drugs (NSAID). Patients did not change their medication during the study. Disease activity was evaluated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), mobility with the Bath Ankylosing Spondylitis Metrology Index (BASMI), functional status with the Bath Ankylosing Spondylitis Functional Index (BASFI), enthesitis with the integrated Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), and quality of life with the Ankylosing Spondylitis Quality of Life (ASQoL) scale. Data related to erythrocyte sedimentation rate, and C-reactive protein were recorded from the hospital information system. The plaque index (PI), gingival index (GI), pocket depth (PD), attachment level (CAL) measurements, and bleeding index (BOP) were measured.ResultsThe results showed that 35.5% of the AS patients had periodontitis, at a lower rate in the anti-TNF group than in the NSAID group, but the difference was not statistically significant. Periodontitis-related factors were found to be age, BASFI and BASMI. A significant relationship was found between MASES and BOP and GI.ConclusionsThis suggests that periodontitis may be an enthesis in AS. Nevertheless, further studies are needed to explain the mechanism of periodontitis in AS patients.     

强直性脊柱炎患者血清DKK-1、VEGF-A、IL-17水平变化及其临床意义

目的探讨强直性脊柱炎(ankylosing spondylitis,AS)患者血清Dickkopf-1蛋白(DKK-1)、血管内皮细胞生长因子-A(VEGF-A)、白细胞介素-17的变化及与患者病情的关系。方法选取我院2016年2月至2017年9月收治的AS患者40例(AS组)、健康体检对象40例(健康组),检测两组的血清DKK-1、VEGF-A、IL-17、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)水平,并分析血清DKK-1、VEGF-A、IL-17与AS患者ESR、CRP、强直性脊柱炎疾病活动指数(BASDAI)、巴氏强直性脊柱炎功能指数(BASFI)的关系。结果 AS组患者的血清DKK-1、VEGF-A、IL-17水平显著高于健康组,差异具有统计学意义(P0. 05); AS组患者的ESR、血清CRP水平显著高于健康组,差异具有统计学意义(P0. 05); AS组患者的BASDAI评估值为(52. 91±10. 62)分、BASFI评估值为(55. 81±9. 70)分; AS患者血清DKK-1、IL-17水平与ESR、血清CRP水平BASDAI评分、BASFI评分呈显著正相关关系(P0. 05); AS患者血清VEGF-A水平与ESR、血清CRP水平BASDAI评分、BASFI评分无显著相关性(P0. 05)。结论 AS患者血清DKK-1、VEGF-A、IL-17水平较健康人群显著升高,其中血清DKK-1、IL-17水平还能在一定程度上反映患者的疾病活动程度。     

Osteoprotegerin and Bone Mass in Squamous Cell Head and Neck Cancer Patients

Osteoprotegerin (OPG) is considered one of the main regulators of bone remodeling. Various patterns of serum OPG levels have been described in different types of tumors. We undertook this study to determine serum OPG levels in patients with squamous cell head and neck cancer (SCHNC), analyzing their relationship with other metabolic bone parameters and bone mineral density (BMD), as well as the possible influence of chemotherapy. Forty male patients with localized SCHNC were studied, and their results were compared with those of 40 healthy male controls. The type of treatment followed by each patient was noted. Age, weight, height, and lifestyle habits were recorded; and OPG, Ca²⁺, intact parathyroid hormone (iPTH), 25-Hydroxyvitamin D (25OHD) and 1,25-Dihydroxyvitamin D (1,25(OH)₂D), bone alkaline phosphatase, osteocalcin, and serum C-terminal cross-links telopeptide of type I collagen (ICTP) were determined. Dual-energy X-ray absorptiometry BMD at the lumbar spine, femoral neck, and hip was also measured. Serum OPG was higher in patients than in controls (91.7 ± 25.8 vs. 77.2 ± 26.3, P = 0.02). ICTP (a bone resorption marker) was 37% higher in patients (P = 0.007). Bone mass was lower in patients at the lumbar spine, femoral neck, and total hip. Lumbar spine Z-score showed a significant progressive decrease in controls, stage I-III patients, and stage IV patients. Logistic regression analysis showed a significant association between the disease and serum OPG levels, the odds ratio per standard deviation increase of this being 1.9 (95% confidence interval 1.1–3.8, P = 0.04) after adjusting for bone mass and ICTP serum levels, as well as for alcohol and smoking history. Adjustment for alcohol intake and tobacco use did not cancel out BMD differences between patients and controls. Patients with SCHNC show increased OPG serum levels, increased bone resorption, and decreased bone mass. The OPG rise appears to be unrelated to the BMD decrease, and the BMD decrease seems to be, at least in part, independent of smoking and drinking habits. No differences in either OPG or BMD were seen between patients with and without chemotherapy. Further studies are needed to clarify the mechanisms responsible for OPG and BMD changes in SCHNC.     

Níveis de vitamina D na espondilite anquilosante: a deficiência corresponde à atividade da doença?

Ankylosing spondylitis (AS) is an inflammatory disorder that presents with arthritis of the axial skeleton, including sacroiliac joints. Vitamin D is a secosteroid hormone with a long‐established role in calcium and phosphate homeostasis, and in the regulation of bone formation and resorption. It is now known that vitamin D plays an immunosuppressive role in the body, and there is interest of late in the role of vitamin D in autoimmune diseases. Inflammation may be responsible for some of the loss of bone mineral density seen in AS. We reviewed the literature for studies assessing vitamin D level as a marker of AS disease activity and those examining vitamin D levels in AS in comparison to healthy controls. Four of 7 studies found a significant negative correlation between vitamin D levels and Bath Ankylosing Spondylitis Index (BASDAI), erythrocyte sedimentation rate (ESR) and C‐reactive protein (CRP). In a review of 8 case‐control studies, the mean level of 25‐hydroxyvitamin D3 was 22.8 ± 14.1 ng/mL in 555 AS patients versus 26.6 ± 12.5 ng/mL in 557 healthy controls. When compared with a 2‐sample t test, vitamin D levels were significantly higher in healthy controls (p < 0.01). We conclude that patients with AS appear to have lower vitamin D levels versus healthy controls; however, the cause is unclear. Existing studies do not demonstrate a consistent link between vitamin D levels and disease activity in AS. Further studies are in need to determine if a causative link exists between vitamin D deficiency and AS.     

Changes of basic bone turnover parameters in short-term and long-term patients with spinal cord injury

The bone mineral density (BMD), the cross- links (PYD, DPD and NTx) and the bone specific alcaline phosphatase (BAP) was investigated in a cross-sectional study in 62 male patients with spinal cord injury (SCI), n = 28 short-term (0–1 year after SCI) and n = 34 long-term SCI patients (> 5 years after SCI). Knowledge about this parameters are necessary to find an adequate therapy for this special kind of osteoporosis. Immobilisation osteoporosis in SCI patients is a well-known problem that may lead to pathological fractures. Little is known regarding the extend of the osteoporosis as well as the causative factors. Measurements of the BMD in the proximal femur and the lumbar spine were performed with dual-energy-X-ray-absorptiometry (DEXA), of the osteoblast marker BAP (bone specific alkaline phosphatase) from serum and the osteoclast markers PYD (pyridinoline), DPD (desoxy-pyridinoline) and NTx (N-telopeptide of collagen type I) from urine. We found a significant decrease of BMD in the proximal femur and no relevant change in the lumbar spine compared to an age- and sex correlated control group (Z-score) in short-term and long-term SCI patients. There was a significant bone loss at the proximal femur between short and long-term SCI patients, whereas at the lumbar spine the BMD even slightly increases. Bone resorption (cross-links) was increased in both groups, though in long-term SCI patients it is significantly decreased compared to short-term SCI patients (DPD from 211.7 u/g creatinine to 118.1 u/g creatinine; NTx from 215.1 nmol/mmol creatinine to 83,6 nmol/mmol creatinine). The bone formation marker BAP is slightly below normal range in both groups (12.3 U/l in short-term, 9.7 U/l in long- term SCI patients). Only the proximal femur is affected by the immobilisation osteoporosis of SCI patients, therefore the BMD measurements in these patients should be performed at the lower limb. The problem of the immobilisation osteoporosis in SCI patients is the striking increase of bone resorption and the missing reaction of the bone formation.     

Sexual function in male patients with ankylosing spondylitis

Sexuality is an important part of healthy life. Patients with ankylosing spondylitis (AS) may be vulnerable to sexual problems because of disease activity and comorbid emotional problems. However, sexuality is a scarcely studied subject in AS. The aim of this study is to compare patients with AS with healthy control. A total of 43 male patients, who referred to the Department of Physical Medicine and Rehabilitation Clinics of the Karadeniz Technical University Farabi Hospital between May 2010 and July 2010, and were diagnosed as AS according to modified New York criteria, were included in the study. Control group consisted of healthy 43 age- and sex-matched male individuals with normal inflammatory levels. The AS patients were compared in means of sociodemographic variables and sexual function with Glombok-Rust Sexual Satisfaction Scale (GRSSS) and clinical interview. Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were used to determine anxiety and depression levels, respectively. The disease activity and functional conditions were evaluated with the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDI). A total of 43 patients with AS and 43 healthy heterosexual male were included in the study. The total GRSSS score was significantly higher in patients with AS, whereas they also had significantly higher sexual complaint than healthy control. The diagnosis of sexual dysfunction according to DSM-IV was significantly higher in the patients with AS as well as depression and anxiety. In study group, GRSSS total score was modestly correlated with disease activity. The psychological status had close relation with sexual functions in AS. Overall assessment is required for complete evaluation in patients with AS.     

Relationships between insulin-like growth factor-I (IGF-I) and OPG, RANKL, bone mineral density in healthy Chinese women

Summary Serum IGF-I level was negatively correlated with OPG and OPG/RANKL ratio, but positively correlated with RANKL. Serum OPG level in the highest quintile of IGF-I was significantly lower than that in the lowest. We conclude that the effect of IGF-I on bone remodeling may be mediated by the OPG/RANKL system. Introduction Insulin-like growth factor I (IGF-I) is an important factor in coupling bone remodeling, activating both formation and resorption. Compared with the many studies on the role of IGF-I in bone formation, the information regarding its effects on bone resorption is limited and conflicting. The balance of the two peptides produced by osteoblasts, osteoprotegerin (OPG) and receptor activator of nuclear factor-κB ligand (RANKL), is critical for the bone resorption process. Our study was designed to analyze the relationships of serum concentrations of IGF-I with OPG, RANKL, OPG/RANKL ratio as well as BMDs in healthy Chinese women. Methods BMDs at lumbar spine and proximal femur in 504 pre- and postmenopausal women were measured by DXA. Serum levels of IGF-I, OPG and RANKL were also measured. Pearson’s correlation and partial correlation analysis, ANOVA, covariance analysis and stepwise multiple regression analysis were used as appropriate. Results Age was negatively correlated with serum levels of IGF-I (r = −0.702, p < 0.001). IGF-I was negatively correlated with OPG and OPG/RANKL ratio, but positively correlated with RANKL. The relationship between IGF-I and BMDs disappeared after adjustment for age. In postmenopausal women, IGF-I was lower in women with osteoporosis than in those with normal BMD (p = 0.056), but no differences were found among OPG, RANKL and OPG/RANKL ratio. Serum levels of OPG in the highest quintile of IGF-I were significantly lower than those in the lowest quintile of IGF-I, while no difference was found in RANKL. In the multiple regression analysis model, serum levels of IGF-I were the main determinants of the bone mass in Chinese women. Conclusions In conclusion, the relationship between decreasing IGF-I and BMDs in healthy Chinese women influenced by age, whereas the effect of IGF-I on bone remodeling (bone resorption) may be mediated by the OPG/RANKL system.