I型胶原吡啶交联末端肽在评价类风湿关节炎 患者病情活动和骨丢失中的临床意义

目的探讨Ⅰ型胶原吡啶交联末端肽(ⅠCTP)在评价类风湿关节炎(RA)病情活动和骨丢失中的重要意义。方法对125例RA女性患者血清,采用酶联免疫吸附试验(ELISA)方法定量检测血清骨代谢指标ⅠCTP、I型胶原羧基末端肽(C区)β降解产物(β-CTX)、Ⅰ型原胶原氨基端前肽(PINP)的浓度,使用DAS28评估RA患者疾病活动指数,影像学sharp评分评估骨侵蚀与狭窄程度,用双能X线吸收仪测定骨密度,并了解患者服用糖皮质激素情况。结果 RA疾病活动组ⅠCTP值明显高于RA疾病稳定组(P<0.01),在排除了糖皮质激素的影响后,差异仍显示有统计学意义。并且血清ⅠCTP值与局部骨侵蚀、狭窄评分呈正相关,与RA全身骨密度无相关性,而血清β-CTX值与全身骨密度呈负相关,与局部骨侵蚀、狭窄评分无相关性。结论Ⅰ型胶原吡啶交联末端肽(ⅠCTP)是评价RA病情活动及局部骨丢失的有效辅助诊断指标,临床观察到ⅠCTP值明显升高时应积极使用RA病情控制药物以防治进一步关节骨破坏。

The clinical value of serum C-terminal cross-linking teiopeptide of type I collagen in the assessment of disease activity and bone loss in patients with rheumatoid arthritis

Objective To explore the clinical value of serum C-terminal cross-linking telopeptide of type I collagen(ICTP) in the assessment of disease activity and bone loss in patients with rheumatoid arthritis(RA).Methods The serum concentration of ICTP,β-CTX,and PINP of 125 female RA patients were measured using ELISA.The disease activity index was evaluated using disease activity score(DAS28).The bone erosion and narrow level were evaluated using image sharp score.Bone mineral density(BMD) was measured with dual-energy X absorptiometry(DXA).The glucocorticoid condition was also acknowledged.Results ICTP in the RA active group were significantly higher than that in the RA stable group(P<0.01).The difference was also significant when the effect of glucocorticoid was excluded.Serum ICTP was positively associated with local bone erosion and narrow level and had no relationship with BMD.However,serum β-CTX was negatively associated with BMD,and had no relation with bone erosion and narrow level.Conclusion Serum ICTP is an effective assistant marker for the evaluation of RA activity and local bone loss.When ICTP obviously increases in clinic,anti-RA drug should be provided to prevent the subsequent joint bone disruption.