朱丹燕　王丹丹　袁远

[摘要] 目的 探讨类风湿关节炎合并骨质疏松患者体内骨代谢和炎症因子的变化。 方法 选取我院2016年7月～2017年9月收治的100例类风湿关节炎患者为观察组，根据是否合并骨质疏松，分为合并骨质疏松组（58例）和非合并骨质疏松组（42例），并选取来我院体检的50例健康人群为对照组，对比分析观察组和对照组以及合并骨质疏松组和非合并骨质疏松组之间骨密度、骨钙素（BGP）和骨保护素（OPG）等骨代谢指标以及C 反应蛋白（CRP）、炎症因子白介素-1β（IL-1β）等炎症因子的表达水平。 结果 与对照组相比，观察组患者骨密度值显著降低，差异有统计学意义（P<0.05）；体内血清骨钙素水平显著升高，差异有统计学意义（P<0.05）；血清骨保护素水平显著降低，差异有统计学意义（P<0.05）；C 反应蛋白和炎症因子白介素-1β水平均显著升高，差异有统计学意义（P<0.05）。与非合并骨质疏松组相比，合并骨质疏松组患者血清骨保护素、C 反应蛋白以及炎症因子白介素-1β水平均较高，差異有统计学意义（P<0.05）；而骨钙素、骨密度水平无显著差异（P>0.05）。 结论 类风湿性关节炎患者合并骨质疏松率的发生率较高，检测患者体内骨钙素（BGP）、骨保护素（OPG）、 C 反应蛋白（CRP）、炎症因子白介素-1β（IL-1β）等骨代谢和炎症因子的表达水平有利于疾病的诊断。

[关键词] 类风湿关节炎；骨质疏松；骨代谢；炎症因子

[中图分类号] R580；R593.22 [文献标识码] A [文章编号] 1673-9701（2017）36-0019-04

[Abstract] Objective To investigate the changes of bone metabolism and inflammatory cytokines in the patients with rheumatoid arthritis complicated with osteoporosis. Methods A total of 100 patients with rheumatoid arthritis who were admitted to our hospital from July 2016 to September 2017 were selected as observation group. According to whether the patients were complicated with osteoporosis， they were divided into osteoporosis group（58 cases） and non-complicated osteoporosis group（42 cases）. 50 healthy people who were given physical examination in our hospital were selected as the control group. The bone metabolism indexes such as bone mineral density （BMD）， bone osteocalcin（BGP） and osteoprotegerin（OPG）， as well as the expression levels of C-reactive protein （CRP）， interleukin-1β （IL-1β） and other inflammatory factors were compared and analyzed between the observation group and the control group， and between the complicated osteoporosis group and non-complicated osteoporosis group. Results Compared with the control group， the BMD in the observation group was significantly lower， and the difference was statistically significant（P<0.05）； in vivo serum osteocalcin levels were significantly increased， and the difference was statistically significant（P<0.05）； serum osteoprotegerin level was significantly lower， and the difference was statistically significant（P<0.05）； C-reactive protein and inflammatory cytokines interleukin-1β levels were significantly increased， and the difference was statistically significant（P<0.05）. Compared with the non-complicated osteoporosis group， the serum osteoprotegerin， C-reactive protein and interleukin-1β levels in the patients in the complicated osteoporosis group were significantly higher， and the difference was statistically significant（P<0.05）； the osteocalcin and bone mineral density were not significantly different（P> 0.05）. Conclusion The incidence rate of rheumatoid arthritis complicated with osteoporosis is high. The detection of the expression levels of osteopontin （BGP）， osteoprotegerin （OPG）， C-reactive protein （CRP）， interleukin-1β （IL-1β） and other bone metabolism indexes and inflammatory cytokines in the patients is helpful for the diagnosis of the disease.

[Key words] Rheumatoid arthritis； Osteoporosis； Bone metabolism； Inflammatory factors

类风湿关节炎（rheumatoid arthritis，RA）[1]是一种病因未明的慢性、以炎性滑膜炎为主的系统性、自身免疫性疾病[2]，其临床主要特征是累及手、足小关节的多关节、对称性、侵袭性关节炎，常有晨僵，常伴有心脏[3]、呼吸系统[4]、肾脏[5]、神经系统等关节外器官受累，最终可导致关节的畸形，甚至功能的丧失。其病理表现主要为滑膜衬里细胞的增生、间质炎细胞的浸润以及骨组织的破坏、血管翳的形成、大量微血管的新生等[6]。其发病机制尚未完全阐明，可能与患者感染、遗传、激素[7]水平等相关。……