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標題: | 高血清濃度的非肝源性鹼性磷酸酶和C-反應性蛋白預測類風濕關節炎患者椎體骨折風險 Higher serum concentrations of non-hepatic alkaline phosphatase and CRP predict the risk of vertebral fracture in patients with rheumatoid arthritis – a preliminary study |
作者: | Jih-Chen Yeh 葉日禎 |
指導教授: | 林思洸 |
關鍵字: | 非肝源性鹼性磷酸?,C反應蛋白,類風濕性關節炎,椎體骨折, non-hepatic alkaline phosphatase,C-reactive protein,rheumatoid arthritis,vertebral fractures, |
出版年 : | 2016 |
學位: | 碩士 |
摘要: | 類風濕關節炎患者處於椎體骨折的高風險。非肝源性鹼性磷酸酶(NHALP)和C反應蛋白(CRP)的血清濃度升高與類風濕性關節炎患者的疾病活性相關。然而,類風濕關節炎患者目前尚未有流行病學研究,關於NHALLP和CRP對椎體骨折的相互作用和共同效應。
我們從2006年1月至2017年6月從醫院數據庫中分析了507例診斷為類風濕關節炎(ICD-9代碼:ICD-9-CM代碼:714.0, 714.2, 714.30-714.33)的患者。對不同程度的血清NHALP和CRP,使用Cox回歸模型,計算椎體骨折的未校正和校正後的風險比(aHR)。使用相互作用產物項確定血清NHALP和CRP對椎體骨折之間的修飾作用。 高血清濃度NHALP(> 150U / L)和CRP(> 3.0mg / dL)與類風濕關節炎患者椎體骨折增加風險相關(aHR:1.8 [95%信賴區間(CI):1.1-2.7]和1.9 [ 95%CI:1.3-2.8]。 NHALP和CRP對椎體骨折事件的相互作用具有統計學意義(p <0.05)。在分層分析中,與最低HR組(ALP <100 U / L和CRP <1mg)相比,合併血清濃度最高的NHALP和CRP患者組別,其椎體骨折風險最高(aHR:3.6 [95%CI:1.5-7.6])。 我們的研究表明,NHALP和CRP的較高血清濃度是椎體骨折的有價值的預測因子,並且相互作用以增加類風濕關節炎患者的椎體骨折風險。組合的NHALP和CRP可作為類風濕關節炎患者椎體骨折的有用替代標誌物。 Patients with RA are at high risk for vertebral fractures (VF). Higher serum concentrations of non-hepatic alkaline phosphatase (NHALP) and C-reactive protein (CRP) are associated with disease activity in patients with rheumatoid arthritis (RA). Nonetheless, no epidemiological study in RA patients has been conducted to investigate the interaction and joint effect of NHALP and CRP on VF. We analyzed 507 patients diagnosed with RA (ICD-9 codes: ICD-9-CM codes: 714.0, 714.2, 714.30–714.33 ) from January 2006 to June 2017 from hospital databanks. Unadjusted and adjusted hazard ratios (aHRs) of VF were calculated for different categories of serum NHALP and CRP using the Cox regression model. The modification effect between serum NHALP and CRP on VF was determined using an interaction product term. Higher serum concentrations of NHALP (NHALP>150U/L) and CRP (>3.0mg/dL) were associated with incremental risks of VF (aHR: 1.8 [95% confidence intervals (CIs): 1.1-2.7] and 1.9 [95% CI: 1.3-2.8] compared to the lowest HR category, respectively). The interaction between NHALP and CRP on VF events was statistically significant (p<0.05). In the stratified analysis, patients with combined highest serum NHALP and CRP had the greatest risk (aHR: 3.6 [95% CI: 1.5-7.6]) compared to the lowest HR group (NHALP < 80 U/L and CRP < 1mg/dL). Our study indicates higher serum concentrations of NHALP and CRP are valuable predictors of VF and interact to increase the risk of VF in RA patients. Combined NHALP and CRP could serve as a useful surrogate marker of VF in RA patients. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/68530 |
DOI: | 10.6342/NTU201704077 |
全文授權: | 有償授權 |
顯示於系所單位: | 臨床牙醫學研究所 |
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