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目的探讨强直性脊柱炎(AS)患者循环骨硬化蛋白与颈动脉内膜厚度和脊柱骨化之间的关系,分析影响AS患者心血管疾病发生的危险因素。方法选择75例AS患者和70例正常对照者作为研究对象。采用ELISA法测定2组受试者血清中骨硬化蛋白的含量。采用超声诊断仪获取颈动脉内膜厚度(IMT),用无创性全自动动脉测量仪器测量患者的脉搏传导速度(PWV),以X线记录AS患者mSASSS评分作为评价骨化进展的放射学指标。运用相关分析法分析骨硬化蛋白水平与IMT、PWV、mSASSS评分及临床活动指标之间的关系。结果 AS患者血中骨硬化蛋白水平明显低于对照组(P<0.01);AS患者组IMT、PWV均明显高于对照组(P<0.01);与IMT正常组相比,IMT增厚组骨硬化蛋白水平显著增高(P<0.01),而钙化组mSASSS评分明显升高;其中骨硬化蛋白水平与IMT、PWV、mSASSS评分呈明显负相关(P<0.05),而IMT、PWV与mSASSS评分明显正相关(P<0.05)。在ROC曲线下,颈动脉内膜增厚的最佳骨硬化蛋白界值为55.1(曲线下面积为0.82,95%CI:0.71~0.87,敏感性为60%,特异性为81%),多元回归分析显示循环骨硬化蛋白水平是IMT独立危险因素。结论 AS患者血中骨硬化蛋白水平的降低伴随动脉粥样硬化和脊柱骨化的发生,可作为预测心血管钙化及骨化程度的生物学指标。
Objective To investigate the relationship between circulating atherosclerosis and carotid intima-media thickness and spinal ossification in patients with ankylosing spondylitis (AS) and to analyze the risk factors influencing the occurrence of cardiovascular diseases in patients with AS. Methods 75 patients with AS and 70 normal controls were selected as the research object. The levels of serum sclerostin in two groups of subjects were determined by ELISA. The intima-media thickness (IMT) of the carotid artery was obtained by using an ultrasonic diagnostic apparatus. The pulse velocity (PWV) of the patients was measured by a noninvasive automatic arterial measuring instrument. The mSASSS score of AS patients was recorded as the radiological index for evaluating the progress of ossification. Correlation analysis was used to analyze the relationship between the levels of sclerosis protein and IMT, PWV, mSASSS score and clinical activity indicators. Results Compared with control group, the level of serum osteocalcin in AS patients was significantly lower than that in control group (P <0.01). IMT and PWV in AS patients were significantly higher than those in control group (P <0.01) Sclerosis protein level was significantly higher (P <0.01), while the calcification group mSASSS score was significantly higher; sclerosis protein level and IMT, PWV, mSASSS score was negatively correlated (P <0.05), and IMT, PWV and mSASSS score was significantly Positive correlation (P <0.05). Under the ROC curve, the best sclerostin cutoff for carotid intimal thickening was 55.1 (area under the curve 0.82, 95% CI 0.71-0.87, sensitivity 60%, specificity 81%), multiple Regression analysis showed that circulating levels of sclerostin were independent risk factors for IMT. Conclusions The decrease of serum levels of sclerosis protein in patients with AS is accompanied by the occurrence of atherosclerosis and ossification of the spine, which may serve as a biological indicator for predicting the degree of cardiovascular calcification and ossification.