Relationship Between Serum TNF-α and IL-34 Levels and Secondary Osteoporosis in Elderly Patients with Rheumatoid Arthritis and Construction of Prediction Model
Objective To study the relationship between serum tumor necrosis factor-α(TNF-α)and interleukin-34(IL-34)levels and secondary osteoporosis in elderly patients with rheumatoid arthritis(RA)and establish a predictive model.Methods A total of 122 elderly RA patients admitted to the Second People's Hospital of Henan Province from January 2020 to January 2023 were selected as the study group,and 100 healthy volunteers were recruited as the control group during the same period.Bone minering density and serum TNF-α and IL-34 levels were measured in all subjects,and bone minering density and serum TNF-α and IL-34 levels were compared between the study group and the control group.The study group was divided into secondary osteoporosis group and non-secondary osteoporosis group according to the degree of bone mineral density reduction.Logistic regression was used to analyze the risk factors of secondary osteoporosis in RA patients,and the prediction model of secondary osteoporosis in RA patients was constructed based on serum levels of TNF-α and IL-34.Receiver operating characteristic(ROC)curve and Hosmer-Lemeshow method were used to evaluate the prediction efficiency and model fit.Results The levels of serum TNF-α and IL-34 in the study group were higher than those in the control group(P＜0.05),and the bone minering density levels of lumbar spine and hip bone were lower than those in the control group(P＜0.05).The proportion of taking antirheumatic drugs,joint function grade(Ⅱ and above),disease course and erythrocyte sedimentation rate(ESR)in secondary group were higher than those in non-secondary group(P＜0.05),and the proportion of weekly fixed exercise was lower than that in non-secondary group(P＜0.05).The levels of serum TNF-α and IL-34 in secondary group were higher than those in non-secondary group(P＜0.05),and the bone minering density levels in lumbar spine and hip bone were lower than those in non-secondary group(P＜0.05).Logistic regression analysis showed that TNF-α,IL-34,course of disease,ESR,taking anti-rheumatic drugs,and joint function grade(grade Ⅱ and above)were independent risk factors for secondary osteoporosis in RA patients(P＜0.05),and weekly fixed exercise was protective factor for secondary osteoporosis in RA patients(P＜0.05).According to the logistic results,the secondary osteoporosis index equation of RA patients was established,and the Hosmer-Lemeshow goodness of fit test results showed that the model had a high goodness of fit(x2=4.326,P=0.389).The area under ROC curve(AUC),sensitivity and specificity of the predictive model for predicting secondary osteoporosis in RA patientswere 0.839(95％CI:0.716-0.943),94.20％and 72.80％,respectively.Conclusion TNF-α,IL-34,course of disease,taking anti-rheumatic drugs,joint function grade(grade Ⅱ and above),ESR are independent risk factors for secondary osteoporosis in RA patients,and the model built based on the above factors has good predictive value for secondary osteoporosis in RA patients.
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