强直性脊柱炎患者血清骨保护素、骨密度、骨代谢生化指标的研究

目的检测强直性脊柱炎(AS)患者血清骨保护素(OPG)、骨代谢指标及骨密度并观察AS患者临床症状、体征、病情活动指标,探讨OPG与AS的关系及与AS骨代谢指标、骨密度的相关性。方法应用酶联免疫法(ELISA)、放射免疫法检测100例AS患者及100例同期健康体检者血清OPG、骨钙素(BGP)、骨碱性磷酸酶(BALP)、Ⅰ型胶原羧基端延长肽(CICP)、Ⅰ型胶原交联C末端肽(CTX)及尿脱氧吡啶啉(DPD)水平。应用双能X线(DEXA)法检测健康对照组与AS患者腰椎、股骨颈、股骨粗隆骨密度,并评价AS患者的BATH功能指数(BASFI)、病情活动指数(BASDAI)、患者总体评价(PGA)、脊柱炎症、脊柱痛及枕墙距、指地距、颌柄距、胸廓活动度、脊柱活动度、Schober试验,对AS患者的血清OPG水平与其他骨代谢指标、骨密度、临床症状、体征指标进行相关性分析。结果AS患者中骨质疏松者35人(35%),骨量减少者42人(42%),AS患者血清OPG、CTX及尿DPD较健康对照组显著增高(P0.05、P0.001、P0.001),AS患者的腰椎、股骨颈、股骨粗隆骨密度较健康对照组显著降低(P0.01、P0.01、P0.01),OPG水平与AS患者各部位的骨密度呈负相关趋势,但无统计学差异。与其他临床指标及骨代谢指标无显著相关性。结论AS患者比健康对照组更易出现骨质疏松和骨量减少,AS患者的骨吸收增强,血清OPG水平增高,其增高原因可能是机体对抗过度骨吸收的保护性反应。

Bone mineral density ( BMD), osteoprotegerin (OPG) and biochemical makers in patients with ankylosing spondylitis (AS)

Objective To assess bone mineral density (BMD), osteoprotegerin (OPG) and biochemical makers in patients with ankylosing spondylitis ( AS) , and to determine their relationships with disease activities.Methods OPG,BALP,DPD,CICPand CTX in 100 AS and 100 healthy controls were measured by ELISA, BGP in 100 AS and 100 healthy controls were measured by RIA.The disease activities were determined using Bath Ankylosing Spondylitis Disease Activity Score Index, Bath Ankylosing Spondylitis Functional Index and PGA and Inflammation, measured as the mean of the last 2 BASDAI questions (intensity and duration of morning stiffness).BMD of femur and lumbar spine was measured in all AS and healthy controls by dual energy X-ray absorptiometry.Radiological grading was determined by New York criteria for sacroiliitis.Results Osteoporosis and osteopaenia of femoral neck were found in 35% and 42% of patients, respectively.Patients with AS had significantly lower BMD of femur and lumbar spine levels than control subjects (P<0.01) ,and had significantly higher mean OPG,CTX,DPD levels than control subjects (P <0.05 , P <0.001 ,P <0.001) .Elevated OPG levels correlated with BMD,but did not show significant correlations with BASDAI, BASFI, PGA, ESR, CRPand other biochemical makers.Conclusion About 77% of AS patients have reduced BMD.Increased bone resorption levels in AS.Serum OPG levels are up-regulated in patients with AS.These results may be due to their increased body protection against excessivebone resorption.