| Objective:This study was designed to investigate the association between bone metabolic markers and general conditions,inflammation levels,general biochemical and immunological parameters,and the differences between the above-mentioned clinical laboratory indicators in patients with different TCM syndrome types.Western medicine perspective on the etiology,pathogenesis and pathogenesis of abnormal bone metabolism caused by RA,in order to further provide evidence for clinical syndrome differentiation.Methods:This study was a prospective study and all patients signed informed consent According to the inclusion criteria,121 patients with RA who were diagnosed and treated by Yueyang Hospital's rheumatology clinic and ward were selected from 2018.5-2019.3.The general data including age,gender,height,weight,course of disease,medication status,personal history,and past history were selected.History,family history,menstruation of female patients and ten questions of Chinese medicine In the course of this study,we need to collect serum samples from patients.In the morning,we will take the specimens of the elbow venous blood for examination in our hospital,and we need to record the following indicators of the patients.(1)Bone Metabolism Index:Serum Osteocalcin(BGP),?-collagen degradation products(?-CTX),type ? collagen carboxy-terminal propeptide(PICP),25-hydroxyvitamin D,bone alkaline phosphatase(BAP),blood Ca,blood P(2 Clinical disease activity indicators:ESR,CRP(3)cytokines:IL-1,IL-2,IL-6,IL-8,TNF-?(4)General biochemical indicators:blood routine(WBC,RBC,Hb,PLT,N),liver and kidney function(Scr,BUN).(5)Immunological indicators:RF,anti-CCP antibody,C3,C4,IgA,IgG,IgM.(6)Bone mineral density:The bone mineral density(BMD)level was measured by dual energy X-ray absorptiometry,and the T values of lumbar vertebrae L1-L4 and femoral neck were recorded.According to the clinical path of sputum(rheumatoid arthritis)formulated by the State Administration of Traditional Chinese Medicine in 2017,combined with symptoms,signs and tongue and pulse,patients were divided into TCM syndromes,which were divided into:cold and dampness syndrome,damp heat Deficiency syndrome,stagnation syndrome and liver and kidney deficiency syndrome 4 syndrome groups.The correlation between the bone metabolic markers of RA patients and the differences of laboratory indicators between different TCM syndrome types were statistically analyzed by SPSS21.0 statistical software.Correlation analysis was performed using Spearman correlation analysis.One-way analysis of variance was used for comparison between groups.LSD test was used for pairwise comparison.All were considered statistically significant at p<0.05 or p<0.01.Results:1.General information:A total of 121 cases of RA were collected,including 26 males and 95 females.The male to female ratio was about 1:4,the average age was 59.48±8.04 years,the average duration was 45.86±24.81 months,and the average height was 162.00±.7.44cm,average weight 58.78±11.03kg.2.The bone mineral density of 121 patients with RA:37 cases(30.60%)with normal bone mass,84 cases(69.40%)with abnormal bone mass,63 cases(52.07%)with bone loss,osteoporosis 21 cases(17.36%).3.Correlation analysis of bone metabolism levels in patients with RA(with general conditions,inflammatory cytokine levels,clinical disease activity indicators,general biochemistry,immunological indicators,bone mineral density):There was a correlation between blood P and gender(p<0.05),and the P level of female patients was significantly lower than that of males;blood Ca and height were negatively correlated(p=0.039<0.05);VitD was negatively correlated with disease duration(r=-0.230,p=0.011<0.05).?-CTX was positively correlated with IL-2 and TNF-?(p<0.05).BAP was negatively correlated with CRP(p=0.001<0.05).There was a negative correlation between C3 and ?-CTX,PICP,BGP and VitD(p<0.05).C4 was positively correlated with Ca(p=0.011<0.05),and IgM was positively correlated with P(p=0.011<0.05).Lumbar vertebrae(T value)was negatively correlated with?-CTX(p=0.039<0.05),and femoral neck(T value)was negatively correlated with?-CTX and PICP(p<0.05).4.Correlation analysis of bone mineral density(BMD)in patients with RA(with general conditions,inflammatory cytokine levels,clinical disease activity indicators,immunological indicators):bone mineral density was negatively correlated with age(p=0.003<0.05),female The bone mineral density was significantly lower than that of males(p=0.003<0.05),and bone mineral density was negatively correlated with disease duration(P=0.003<0.05).The femoral neck(Tvalue)was negatively correlated with IL-2(r=-0.203,p=0.026<0.05).Lumbar vertebrae(Tvalue)and TNF-? were negatively correlated(p=0.012<0.05);femoral neck(Tvalue)and TNF-? were negatively correlated(p=0.014<0.05).There was no significant correlation between bone mineral density and ESR,CRP,C3,C4,IgA,IgG and IgM(P>0.05).5.Distribution characteristics of TCM syndromes in patients with RA:Among them,there were 25 cases(20.66%)with wind-cold dampness syndrome,34 cases(28.09%)with damp-heat block,and 33 cases(27.27%)with liver and kidney.There were 29 cases(23.98%).6.The number and proportion of normal bone abnormalities in different TCM syndrome groups of RA:Among them,14 cases(56.00%)had abnormal bone mass in the cold and dampness syndrome,and 22 cases(64.71%)had abnormal bone mass in damp heat and stasis syndrome.There were 24 cases(72.73%)with abnormal bone mass and 24 cases(82.76%)with abnormal liver mass.7.Difference analysis between different TCM syndrome types(with general conditions,bone metabolism levels,inflammatory cytokine levels,clinical disease activity indicators,general biochemical,immunological indicators and bone mineral density):patients with liver and kidney deficiency syndrome It was significantly longer than the other three groups(p<0.05).The highest level of ?-CTX metabolism was liver and kidney deficiency syndrome,followed by stagnation syndrome,and there was no significant difference between the syndrome of wind-cold dampness and damp-heat phlegm.The metabolic levels of PICP,PICP,and BGP were high to low,which was the syndrome of liver and kidney deficiency,phlegm stasis syndrome,dampness and heat syndrome,and wind-cold dampness syndrome(p<0.05).The level of BAP metabolism in liver and kidney deficiency syndrome was significantly higher than that in cold and dampness syndrome and dampness and heat stasis syndrome(p<0.05).The metabolic level of P in liver and kidney deficiency syndrome was significantly higher than the other three groups(p<0.05).The metabolic level of TNF-? in patients with wind-cold dampness syndrome was significantly lower than that of phlegm-reducing syndrome and liver-kidney deficiency syndrome(p<0.05).The ESR level of dampness and heat stasis syndrome was significantly higher than that of the two groups(p<0.05).The T value of lumbar vertebrae was significantly lower than that of phlegm and blood stasis syndrome(p<0.05).The T value of femoral neck of liver and kidney deficiency syndrome was significantly lower than that of cold and dampness syndrome and dampness and heat stasis syndrome(p<0.05).Conclusion:1.In women with RA,the older,the longer the course of disease,the more obvious bone loss.2.Bone destruction and bone formation markers ?-CTX,PICP were negatively correlated with bone mineral density,indicating that patients with RA had abnormalities in osteogenesis and osteolysis,and bone metabolism was highly converted.3.Bone mineral density and ?-CTX levels in RA patients were positively correlated with IL-2 and TNF-? indicators reflecting disease activity.IL-2 and TNF-? may be involved in RA bone metabolism indirectly through mediating inflammatory reactions.4.Among the five syndrome types,the course of liver-kidney deficiency syndrome was longer,and the bone mineral density of liver-kidney deficiency syndrome was significantly lower than that of wind-cold dampness,damp-heat syndrome and phlegm block.5.There are differences in ?-CTX,PICP and BGP between different TCM syndrome types,and the evidence of liver and kidney deficiency is higher than the other three groups,indicating that there is a high rate of bone turnover in liver and kidney deficiency syndrome.Therefore,the diagnosis and treatment should be based on The concept of "kidney bone" is to treat the kidney to slow down the loss of bone mass. |
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