瘤壞死因子對強直性脊柱炎(AS)患者骨微結構的影響

瘤壞死因子對強直性脊柱炎(AS)患者骨微結構的影響： 基於高解析度外周定量CT (HRPQCT) 的縱向研究

腫瘤壞死因子抑製劑對強直性

脊柱炎(AS)患者骨微結構的影響：

基於高解析度外周定量

CT (HRPQCT) 的縱向研究

目 的

本研究旨在評估腫瘤壞死因子（TNFi）對AS患者骨微結構的影響 。

方 法

根據修訂的紐約標準（Modified New York）定義AS。使用雙能X線骨密度儀（DXA）測定面積骨密度（areal BMD)，使用高解析度外周定量CT（HRpQCT）測定基線處和接受一年半的TNFi治療後橈骨和脛骨的體積骨密度（vBMD）和骨微結構，優化鈣和維生素D的攝入。

結 果

共有31名受試者（58％為男性）。平均（+SD）年齡和強直性脊柱炎疾病活動指數（BASDAI）分別為40+14歲和4.1+2.1。病程中位數為14（IQ：6.5-25.5）年。平均隨訪時間為15個月。腰椎（1.053 + 0.235 vs. 1.049 + 0.202，p = 0.89）、全髖（0.944 + 0.152 vs. 0.912 + 0.164，p = 0.5）和股骨頸（0.955 + 0.151 vs 0.954 + 0.191，p = 0.2）的面積骨密度（n = 22）沒有顯著變化。HRpQCT（n = 31）隨訪顯示，橈骨和脛骨的整體、骨小梁和骨皮質體積和骨密度均未發生變化。此外，基於HRpQCT的骨小梁參數，如骨小梁數量、厚度和間距，BV / TV以及骨皮質孔隙度和厚度等皮質參數保持穩定。隨訪時橈骨的骨強度和骨應力的FEA估計值較低，但脛骨的相關參數沒有顯著差異。

結 論

這是第一個記錄了接受TNFi治療的AS患者的骨強度變化的研究。它表明接受TNFi治療可能會維持AS患者骨皮質和骨小梁的骨微結構。

原 文

Effect of tnf inhibitors on bone microarchitecture in patients with ankylosing spondylitis: a longitudinal study based on high-resolution peripheral quantitative based (HRPQCT)

Objectives

This study aimed to assess the effect of TNF inhibitors on bone microarchitecture in patients with AS.

Methods

AS was defined by Modified New York criteria. Areal BMD was measured by DXA. Volumetric BMD (vBMD) and bone microarchitecture were measured using highresolution peripheral quantitative CT (HRpQCT) at the radius and tibia at baseline and after one year of treatment with TNF inhibitors. Intake of calcium and vitamin D were optimised.

Results

There were 31 subjects (58% men). Mean (+SD) age and BASDAI were 40+14 years and 4.1+2.1respectively. Median duration of disease was 14 (IQ: 6.5–25.5) years. Mean duration of follow-up was 15 months. Areal BMD (n=22) at lumbar spine (1.053+0.235vs. 1.049+0.202,p=0.89), total hip (0.944+0.152vs. 0.912+0.164,p=0.5), and femoral neck (0.955+0.151vs. 0.954+0.191,p=0.2) did not change significantly. HRpQCT (n=31) on follow-up demonstrated that total, trabecular and cortical volumetric BMD were unchanged at both radius and tibia. Also, HRpQCT based trabecular parameters such as trabecular number, thickness and separation, BV/TV and cortical parameters such as cortical porosity and thickness remained stable. FEA estimates of bone stiffness and stress tended to be lower at the radius on follow-up however these parameters were not significantly different at the tibia.

Conclusions

This is the first study to document the changes in bone strength in AS patients with the use of TNF inhibitors. Treatment with TNF inhibitors might maintain bone microarchitecture at cortical and trabecular sites in patients with AS.

文章出處：

N. Nigil Haroon, E. Szabo, A.M. CHEUNG, R. Inman. Annals of the Rheumatic Diseases. https://ard.bmj.com/content/77/Suppl_2/1549.2

2018年6月12日首次發表

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