Correlation of Nailfold Microcirculation Abnormality with Disease Activity and Osteoporosis in Female Patients with RA　#br#

doi:10.3969/j.issn.1007-9572.2017.00.204

Abstract

Abstract: Objective　To explore the clinical significance of nailfold microcirculation abnormality in disease activity and osteoporosis in female patients with rheumatoid arthritis（RA）．Methods　This study was conducted in 320 cases selected from Shengli Oilfield Central Hospital，including 240 RA females（case group） who received treatment in Department of Rheumatology and Immunology from August 2015 to March 2017 and 80 healthy females underwent physical examination（control group） in Physical Examination Center during the same period.We collected their clinical data，including erythrocyte sedimentation rate（ESR） result，levels of C-reactive protein（CRP），rheumatoid factor（RF），anti-cyclic citrullinated peptide（anti-CCP） antibodies and antinuclear antibody（ANA），nailfold capillaroscopy score，levels of serum 25-hydroxyvitamin D 〔25（OH）D〕, VEGF and osteoprotegerin（OPG） detected by ELISA，and bone mineral density measured by dual-energy X-ray absorptiometry.Patients in the case group were divided into mild，moderate and high RA activity subgroups according to DAS 28，and mild RA subgroup（48 cases），moderate RA subgroup（136 cases） and severe RA subgroup（56 cases） based on “TIAN Niu's weighted integration method of nailfold microcirculation”.Multiple linear regression analysis was performed to investigate the associated factors for disease activity in patients with RA.Multivariate Logistic regression analysis was conducted to explore the associated factors for osteoporosis.Results　The nailfold capillaroscopy score was markedly higher in the case group than that of the control group 〔（6.1±1.9） vs.（4.7±1.5），t=5.995，P<0.05）〕.The distribution of nailfold microcirculation abnormality between the case group and the control group was significantly different（u=-8.000，P<0.01）．The nailfold capillaroscopy score increased with the severity of RA（P<0.05），namely，the nailfold capillaroscopy score in the high RA activity subgroup was the highest but in the mild RA activity subgroup it was the lowest.The age，course of RA，prevalence of RF and ANA did not differ significantly by degree of nailfold microcirculation abnormality（P>0.05），but the prevalence of abnormal ESR and CRP，levels of VEGF，OPG and 25（OH）D，prevalence of anti-CCP antibodies，DAS 28，prevalence of decreased bone mass and osteoporosis were differed obviously by degree of nailfold microcirculation abnormality（P<0.05）．Compared with the mild RA subgroup，the level of ESR and CRP，prevalence of anti-CCP antibodies，DAS 28 and VEGF，prevalence of decreased bone mass and osteoporosis were higher while the 25（OH）D
and OPG levels were lower in the moderate RA subgroup（P<0.01）．Compared with the mild and moderate RA subgroups，the ESR，CRP，DAS 28，VEGF were higher while 25（OH）D and OPG were lower in the severe RA subgroup（P<0.01）．The prevalence of anti-CCP antibodies，decreased bone mass and osteoporosis was higher in the severe RA subgroup compared with the mild RA subgroup（P<0.01）．Nailfold microcirculation score in the case group was positively correlated with DAS 28（r=0.575，P<0.05），ESR（r=0.529，P<0.05），CRP（r=0.420，P<0.05），the titer of anti-CCP antibodies（r=0.413，P<0.05），but negatively correlated with 25（OH）D（r=-0.595，P<0.05）and OPG（r=-0.538，P<0.05）．Multiple linear regression analysis showed that ESR〔β=0.033，95%CI（0.001，0.065），P=0.043〕，anti-CCP antibodies 〔β=0.008，95%CI（0，0.068），P=0.044〕，nailfold capillaroscopy score 〔β=0.484，95%CI（0.355，0.614），P<0.001〕 was the associated factor of disease activity in female RA patients.Multivariate Logistic regression analysis showed that age 〔OR=1.150，95%CI（1.020，1.291），P=0.025〕 and nailfold capillaroscopy score 〔OR=2.980，95%CI（1.184，7.502），P=0.033〕 were the risk factors for osteoporosis in female RA patients，while 25（OH）D 〔OR=0.005，95%CI（0.003，0.007），P=0.032〕 and OPG 〔OR=0.907，95%CI（0.842，0.977），P<0.001〕 were protective factors for osteoporosis in female patients with RA.Conclusion　Nailfold microcirculation abnormality is associated with disease activity and osteoporosis in female RA patients.As increased nailfold capillaroscopy score is a risk factor for disease activity and the occurrence of osteoporosis，nailfold capillaroscopy examination can be used as a potential tool to predict the occurrence of osteoporosis in female RA patients.

Key words: Arthritis, rheumatoid；Microcirculation；Osteoporosis；25-Hydroxyvitamin D；Bone density

摘要：

目的　探讨女性类风湿关节炎（RA）患者甲襞微循环异常与疾病活动度及骨质疏松发生的相关性。方法　选择2015年8月—2017年3月就诊于胜利油田中心医院风湿免疫科的女性RA患者240例为病例组，同时收集同期于本院体检中心体检健康女性80例为对照组，记录患者的临床资料，检测红细胞沉降率（ESR）、C反应蛋白（CRP）、类风湿因子（RF）、抗环瓜氨酸多肽抗体（CCP）、抗核抗体（ANA）等，测定甲襞微循环积分，采用酶联免疫吸附试验法测定25羟基维生素D〔25（OH）D〕、血管内皮生长因子（VEGF）、骨保护素（OPG）水平，运用双能X线吸收仪测定 RA 患者骨密度。根据DAS 28积分分为低度活动、中度活动、高度活动，采用“田牛甲襞微循环加权积分法”标准将患者分为轻度亚组48例、中度亚组136例、重度亚组56例。RA患者疾病活动度的影响因素采用多元线性回归分析，骨质疏松发生影响因素采用多因素Logistic回归分析。结果　病例组患者甲襞微循环积分高于对照组〔（6.1±1.9）分与（4.7±1.5）分，t=5.995，P<0.05〕。病例组与对照组甲襞微循环异常分布比较，差异有统计学意义（u=-8.000，P<0.01）。病例组中度活动患者甲襞微循环积分较低度活动者升高，重度活动患者甲襞微循环积分较低度活动和中度活动者升高（P<0.05）。病例组不同程度甲襞微循环异常患者年龄、病程、RF阳性率、ANA阳性率比较，差异均无统计学意义（P>0.05）；病例组不同程度甲襞微循环异常患者ESR、CRP、CCP阳性率、DAS 28积分、25（OH）D、VEGF、OPG水平、骨量下降及骨质疏松发生率比较，差异均有统计学意义（P<0.05）；其中中度亚组患者ESR、CRP、CCP阳性率、DAS 28积分、VEGF水平、骨量下降及骨质疏松发生率高于轻度亚组，25（OH）D、OPG水平低于轻度亚组（P<0.01）；重度亚组患者ESR、CRP、DAS 28积分、VEGF水平高于轻度亚组和中度亚组，25（OH）D、OPG水平低于轻度亚组和中度亚组，CCP阳性率和骨量下降及骨质疏松发生率高于轻度亚组（P<0.01）。病例组患者甲襞微循环积分与DAS 28积分（r=0.575，P<0.05）、ESR（r=0.529，P<0.05）、CRP（r=0.420，P<0.05）、CCP滴度（r=0.413，P<0.05）呈正相关，与25（OH）D（r=-0.595，P<0.05）、OPG（r=-0.538，P<0.05）呈负相关。多元线性回归分析显示，ESR〔β=0.033，95%CI（0.001，0.065），P=0.043〕、CCP滴度〔β=0.008，95%CI（0，0.068），P=0.044〕、甲襞微循环积分〔β=0.484，95%CI（0.355，0.614），P<0.001〕是女性RA患者疾病活动度的影响因素。多因素Logistic回归分析显示，年龄和甲襞微循环积分是女性RA患者骨质疏松的危险因素〔OR=1.150，95%CI（1.020，1.291），P=0.025；OR=2.980，95%CI（1.184，7.502），P=0.033〕，而25（OH）D和OPG是女性RA患者骨质疏松的保护因素〔OR=0.005，95%CI（0.003，0.007），P=0.032；OR=0.907，95%CI（0.842，0.977），P<0.001〕。结论　女性RA患者甲襞微循环异常与疾病活动度及骨质疏松发生相关；甲襞微循环积分升高是疾病活动度增加及骨质疏松发生的危险因素；甲襞微循环检查可作为一种预测RA骨质疏松发生的潜在诊断工具。

关键词: 关节炎, 类风湿, 微循环, 骨质疏松, 25-羟维生素D, 骨密度

YU Chun-yan1,ZHANG Lei1*,GAO Zhao-meng1, et al. Correlation of Nailfold Microcirculation Abnormality with Disease Activity and Osteoporosis in Female Patients with RA　#br#[J]. Chinese General Practice, 2018, 21(20): 2437-2443. DOI: 10.3969/j.issn.1007-9572.2017.00.204.
于春艳1,张磊1*,高照猛1等. 女性类风湿关节炎患者甲襞微循环异常与疾病活动度及骨质疏松发生的相关性研究[J]. 中国全科医学, 2018, 21(20): 2437-2443. DOI: 10.3969/j.issn.1007-9572.2017.00.204.

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