| Objective: Systemic lupus erythematosus is a diffuse connective tissue disease which is characterized by chronic inflammation and multi-organ injuries.Due to the autoimmune disorders,a variety of autoantibodies and reactive cells are appeared in vivo.In recent years,along with the deep research and the improvement of diagnosis and treatment,the survival rate has been significantly increased.But with the progression of disease and the usage of glucocorticoids and immunosuppressants,the long-term complication—osteoporosis,is inevitable.Osteoporosis(OP)is a general bone metabolic disease characterized by low bone mass and microarchitechtural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture incidence.Biochemical markers of bone turnover are the products of bone tissue metabolism,including bone formation makers and bone resorption makers.Bone formation markers represent metabolites of osteoblast activity and bone formation,PINP is recommended for bone formation makers in the word.While Bone resorption markers are the metabolites of osteoclastic activity and bone resorption,β-CTX is internationally recommended.Bone turnover biochemical markers reflect the metabolic balance of bone formation and resorption,which often precede the change of bone mineral density(BMD).These markers are very important for the early detection of bone changes and the prevention of OP.A large meta-analyses have confirmed that whether treat or not,the risks of OP in SLE patients are significantly higher than those of healthy people.These findings suggest that besides the drugs,disease itself is also involved in the occurrence and development of OP.The more severe of the disease,the more serious of bone loss,especially the lumbar spine and femoral bone.The cause of OP in SLE is complicated,immunoserology factors,disease activity,chronic inflammation,metabolic factors,abnormalhormone levels,psychoneural factors,lifestyle and so on,all above can induce op or plan an important role.A long-term use of glucocorticoids can lead to OP,which has become a clinical consensus.However,whether the disease itself can affect bone metabolism or induce OP is rarely researched.In this research,we measured the BMD(bone mineral density)of lumbar spine and left hip in patients with SLE,and analyzed PINP,β-CTX levels in the serum.Moreover,correlation analyses were made among these values and SLEDAI,duration,immunological indexes,erythrocyte sedimentation rate(ESR)and Creactive protein(CRP)to discuss the importance of bone turnover biochemical markers and BMD in SLE.These helped us to make new bases of prevention,early diagnosis or treatment in SLE patients with secondary OP.Methods:1 We screened 52 untreated SLE patients(45 female,7 male)as the experimental group and 28 healthy subjects(24 femal,4male)as control group.According to SLE disease activity index(SLEDAI)score,SLE patients were divided into three groups:the mild activity group(5≤SLEDAI≤9,13cases),moderate activity group(10≤SLEDAI≤14,15 cases),and severe activity group(SLEDAI≥15,27 cases).Based on disease duration,they were divided into early course group(duration≤3 months,24 cases),middle course group(3months<duration≤1 year,14 cases),and late course group(duration>1 year,14cases).According to dual-energy X-ray absorptiometry results of lumbar spine and left hip,patients were divided into normal BMD group(27 cases),low BMD group(22 cases),OP group(3 cases).2 The PINP andβ-CTX levels in serum were assayed by enzyme linked immunosorbent assay technique(ELISA).According to the diagnostic criteria of OP which formulated by Chinese Medical Association of Osteoporosis and Bone Mineral Salt Disease Branch in 2011,BMD of the left hip and lumbar spine in SLE patients were examined by dual-energy X-ray absorptiometry to evaluate the bone mineral density.3 The age,gender,body mass index(BMI),clinical manifestation and laboratory findings were recorded.The BMD,serum PINP and β-CTX indifferent groups were compared and analyzed,coupled with association analyses.4 Data were analyzed by SPSS21.0 statistical software.Results:1 The whole left hip BMD and serum calcium in SLE group were significantly lower than the control group,PINP andβ-CTX levels were higher than control group(P<0.05).2 The left hip BMD and serum calcium in mild and moderate activity group were lower than the control group,serumβ-CTX was higher than control group(P<0.05).The serum calcium in severe activity group was lower than the control group,mild and moderate activity group.PINP andβ-CTX were higher than the control group(P < 0.05),all the differences are statistically significant.3 The lumbar spine BMD in early course group was higher than the control group(P<0.05).The left hip BMD in middle and late course group and the femoral neck BMD in middle course group were lower than the control group(P < 0.05).The serum calcium in three course groups was lower than control group(P<0.05).The serum β-CTX in three course group and PINP in middle course group were higer than control group(P < 0.05).The left hip BMD in middle course group was lower than early course group,and serum PINP was significantly higher than the early course(P < 0.05).The lumbar spine and left hip BMD in late course group were lower than the early group and PINP was lower than the middle group(P<0.05).4 There were no differences in immunoglobulin,complement,ESR and CRP between the normal BMD group and abnormal BMD group(P<0.05).5 Serum calcium in three different ANA group were lower than control group(P<0.05).Serumβ-CTX in three ANA group and PINP in homogeneous type and mixed type ANA group were higher than control group(P <0.05).The left hip in particle type ANA group and serum phosphate in mixed type group were lower than control group(P < 0.05),all the differences are statistically significant.6 Serum calcium in anti-dsDNA,anti-Sm and anti-nucleosome antibodies positive group were lower than the negative group(P<0.05).There were no differences in BMD and bone metabolism between ACL,anti-SSA,antiU1 RNP,anti-SSB,anti-rRNP antibodies negative group and positive group.7 There were negative correlation between lumbar spine,left hip BMD and disease duration(P<0.05).Serum calcium was negatively correlated with SLEDAI score,ESR,and positively correlated with IgA,C3 and C4(P <0.05).Serum PINP was positively was positively correlated with CRP(P <0.05).Conclusions:1 Low BMD can be found in untreated SLE patients,hip is commonly involved.2 In untreated SLE patients,lumbar spine and hip BMD are negatively correlated with disease duration.3 The level of serum calcium is significantly decreased in untreated SLE patients,and it is negatively correlated with SLEDAI score and ESR,positively correlated with IgA and complement.4 The biochemical markers of bone turnover —serum PINP,β-CTX—are increased in SLE patients.It is suggest that bone metabolism is active in SLE. |
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