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目的:探讨免疫球蛋白、淋巴细胞亚群、白细胞介素(interleukin，IL)27和IL-6在类风湿关节炎(rheumatoid arthritis，RA)合并骨质疏松(osteoporosis，OP)患者中的表达及临床意义。方法:选取2018年1月至2020年12月沭阳县中医院收治的268例RA患者为研究对象，测定所有患者的骨密度(bone mineral density，BMD)水平，根据测定结果以及患者是否存在脆性骨折史判定患者是否合并OP，其中未合并OP的195例患者纳入研究组1，合并OP的73例患者纳入研究组2，收集两组的临床资料；另外选取同时期在本院进行健康体检的健康人100例纳入对照组，测定研究组和对照组患者免疫球蛋白、淋巴细胞亚群、IL-27和IL-6水平，分析RA合并OP患者与上述指标间的相关性。结果:研究组1的性别、年龄、RA病程、关节肿胀数(swollen joint count，SJC)、关节压痛数(joint tenderness，TJC)、红细胞沉降率(erythrocyte sedimentation rate，ESR)、28处关节疾病活动度评估(disease activity score-28，DAS-28)与研究组2对比差异具有统计学意义[(男81例，女114例)比(男20例，女53例)，(52.49±4.86)岁比(59.51±4.90)岁，(5.41±1.23)年比(7.65±1.52)年，(4.26±1.09)个比(5.63±1.14)个，(8.21±2.24 )个比(9.02±2.35)个，(51.69±4.82)mm/h比( 65.23±5.07)mm/h，35/84/76比5/12/56，n χ2/n t/n U值分别为4.52、23.73、17.85、9.05、5.15、23.90、5.22，n P值均<0.05]。研究组1和研究组2的免疫球蛋白(immunoglobulin，Ig)A、IgG和IgM水平均高于对照组[g/L：(4.56±1.02)、(5.63±1.15)比(2.71±0.36)，(16.63±2.34)、(25.66±3.82)比(13.05±2.03)，(3.35±0.36)、(3.91±0.42)比(2.35±0.33)，n F值分别为232.50、502.57、425.60，n P值均0.05]；但研究组1和研究组2的CD4n +及CD4n +/CD8n +水平均低于对照组[%：(40.52±5.41)、(34.28±4.26)比( 43.85±3.89)；(1.42±0.33)、(1.28±0.26)比(1.51±0.35)，n F值分别为84.12、10.71，n P值均<0.05)。研究组1和研究组2与对照组患者IL-27和IL-6水平差异具有统计学意义[ng/mL：(9.85±1.26)、(13.52±1.54)比(7.05±1.13)；pg/mL：(72.58±10.33)、(207.64±15.89)比(57.64±9.85)，n F值分别为532.83，4380.37，n P值均0.05)；IgA、IgG、IgM、IL-27和IL-6与BMD之间为负相关性(n r＝-0.48、-0.64、-0.53、-0.66、-0.71，n P值均<0.05)；而CD4n +和CD4n +/CD8n +与BMD之间呈正相关性(n r＝0.76、0.60，n P<0.05)。n 结论:RA合并OP患者免疫球蛋白、IL-27和IL-6水平与患者BMD的变化密切相关，早期通过对上述指标的监测，及时采取有效的措施预防OP的发生，以此改善患者的预后情况和生存质量。“,”Objective:To investigate the expression level and clinical significance of immunoglobulin, lymphocyte subsets, interleukin(IL)-27 and IL-6 in patients with rheumatoid arthritis(RA) complicated with osteoporosis(OR).Methods:A total of 268 RA patients admitted from January 2018 to December 2020 were selected as the study subjects from Shuyang Hospital of Traditional Chinese Medicine . The bone mineral density (BMD) level of all patients was measured, and the patients with OP were determined based on the results and the history of brittle fracture. Including unincorporated OP 195 patients were regarded as group 1, merge the OP 73 patients as group 2, in addition to select the physical examination of healthy people 100 cases in control group the same period in our hospital. Immuneglobulin(Ig), lymphocyte subgroup, and the levels of IL-6, IL-27 of he group and the control group patients were detected. The correlation between RA patients with OP and the above indicators was analyzed.Results:Age, AR course, swollen joint count (SJC), joint tenderness (TJC), erythrocyte sedimentation rate(ESR), disease activity score of 28 joints (DAS-28)showed statistically significant differences betwent study group and control group [(81 males, 114 females) vs (20 males, 53 females), (52.49±4.86) vs (59.51±4.90), (5.41±1.23) vs (7.65±1.52), (4.26±1.09) vs (5.63±1.14), (8.21±2.24) vs (9.02±2.35), (51.69±4.82) vs (65.23±5.07), 35/84/76 vs 5/12/56, n χ2/n t/n U values were 4.52, 23.73, 17.85, 9.05, 5.15, 23.90, 5.22, respectively, all n P values <0.05). The levels of IgA, IgG and IgM in study group 1 and study group 2 were higher than those in control group [g /L: (4.56±1.02), ( 5.63±1.15)vs(2.71±0.36), (16.63±2.34), (25.66±3.82)vs( 13.05±2.03), (3.35±0.36), (3.91±0.42) to (2.35±0.33), n F values were 232.50, 502.57, 425.60, all n P values 0.05). However, the levels of CD4n + and CD4n + /CD8n + in study group 1 and study group 2 were lower than those in control group [% : (40.52±5.41), (34.28±4.26) vs( 43.85±3.89); (1.42±0.33), (1.28±0.26) vs (1.51±0.35), n F values were 84.12, 10.71, both n P values < 0.05). There were statistically significant differences in IL-27 and IL-6 levels between study group 1 , study group 2 and control group [ng/mL: (9.85±1.26), (13.52±1.54) vs. (7.05±1.13); pg /mL: (72.58±10.33), (207.64±15.89) vs (57.64±9.85), n F values were 532.83, 4380.37, all n P values 0.05). IgA, IgG, IgM, IL-27 and IL-6 were negatively correlated with BMD (n r=-0.48, -0.64, -0.53, -0.66, -0.71, all n P values <0.05). CD4 n + and CD4n + /CD8n + were positively correlated with BMD (n r=0.76, 0.60, all n P values <0.05).n Conclusion:The levels of Ig, IL-27 and IL-6 in patients with RA combined with OP are closely related to the changes in bone mineral density of patients. Early monitoring of the above indicators can take timely and effective measures to prevent the occurrence of OP, so as to improve the prognosis and quality of life of patients.