血清Dickkopf-1蛋白、ESR、VEGF-A与强直性脊柱炎患者病情及发生脊柱骨折的关系

The relationship of serum DKK1, ESR and VEGF-A values with the condition and occurrence of spinal fractures in patients with ankylosing spondylitis

摘要:

目的 探讨血清Dickkopf-1蛋白、血沉（ESR）、血管内皮细胞生长因子-A（VEGF-A）与强直性脊柱炎患者病情及发生脊柱骨折的关系。方法 选取2020年1月—2022年8月广州中医药大学附属深圳平乐骨伤科医院收治的54例发生脊柱骨折的强直性脊柱炎患者作为骨折组，并选取未发生脊柱骨折的强直性脊柱炎患者70例作为对照组。比较两组的年龄、性别、病程、Dickkopf-1蛋白、ESR、VEGF-A、腰椎骨密度T值、强直性脊柱炎疾病活动指数（BASDAI）、巴氏强直性脊柱炎功能指数（BASFI）、血清C反应蛋白（CRP）、指-地距离。采用Pearson法分析Dickkopf-1蛋白、ESR、VEGF-A与BASDAI、BASFI的相关性。采用多因素一般Logistic回归模型分析强直性脊柱炎患者发生骨折的影响因素。结果 骨折组与对照组的腰椎骨密度T值、BASDAI、BASFI、血清CRP、指-地距离比较，差异均有统计学意义（P <0.05）。骨折组患者的Dickkopf-1蛋白、ESR、VEGF-A均高于对照组（P <0.05）。骨折组患者BASDAI评分与Dickkopf-1蛋白、ESR、VEGF-A均呈正相关（r =0.577、0.596和0.714，均P =0.000）；骨折组患者BASFI评分与Dickkopf-1蛋白、ESR、VEGF-A均呈正相关（r =0.502、0.586和0.686，均P =0.000）。腰椎骨密度T值降低［O^R =1.770（95% CI：1.150，2.724）］、BASDAI评分升高［O^R =1.168（95% CI：1.008，1.353）］、BASFI评分升高［O^R =1.202（95% CI：1.302，1.401）］、Dickkopf-1蛋白升高［O^R =1.486（95% CI：1.034，2.135）］、VEGF-A升高［O^R =1.857（95% CI：1.077，3.202）］均是强直性脊柱炎患者并发骨折的独立危险因素（P <0.05）。结论 Dickkopf-1蛋白、VEGF-A及ESR水平与强直性脊柱炎患者病情有关，与患者发生脊柱骨折关系密切。

Abstract:

Objective To explore the relationship between serum Dickkopf-1 protein, erythrocyte sedimentation rate (ESR), vascular endothelial growth factor-A (VEGF-A), and the condition and occurrence of spinal fractures in patients with ankylosing spondylitis (AS).Methods Fifty-four AS patients who suffered spinal fractures admitted to the Shenzhen Ping Le Orthopedic Hospital, affiliated with Guangzhou University of Chinese Medicine, from January 2020 to August 2022 were selected as the fracture group, and 70 AS patients without spinal fractures were selected as the control group. The age, gender, course of disease, Dickkopf-1 protein, ESR, VEGF-A, lumbar spine bone density T value, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), serum C-reactive protein (CRP), and Schober's test distance were compared between the two groups. Pearson correlation analysis was used to analyze the correlation between Dickkopf-1 protein, ESR, VEGF-A, BASDAI, and BASFI. Multifactorial logistic regression analysis was used to analyze the influencing factors of spinal fractures in AS patients.Results The lumbar spine bone density T value, BASDAI, BASFI, serum CRP, and Schober's test distance were significantly different between the fracture group and the control group (P < 0.05). The levels of Dickkopf-1 protein, ESR, and VEGF-A in the fracture group were higher than those in the control group (P < 0.05). The BASDAI scores of the fracture group patients were positively correlated with Dickkopf-1 protein, ESR, and VEGF-A (r = 0.577, 0.596, and 0.714, respectively, all P = 0.000); the BASFI scores of the fracture group patients were positively correlated with Dickkopf-1 protein, ESR, and VEGF-A (r = 0.502, 0.586, and 0.686, respectively, all P = 0.000). Decreased lumbar spine bone density T value [O^R =1.770(95% CI: 1.150, 2.724)], increased BASDAI score [O^R =1.168(95% CI: 1.008, 1.353)], increased BASFI score [O^R =1.202(95% CI: 1.302, 1.401)], elevated Dickkopf-1 protein [O^R =1.486(95% CI: 1.034, 2.135)], and elevated VEGF-A [O^R =1.857(95% CI: 1.077, 3.202)] were independent risk factors for spinal fractures in AS patients (P < 0.05).Conclusion Levels of Dickkopf-1 protein, VEGF-A, and ESR are associated with the condition of AS patients and closely related to the occurrence of spinal fractures in these patients.