类风湿关节炎患者全身骨质疏松和局部骨侵蚀的关系研究  

Association of general osteoporosis and local bone erosion in patients with rheumatoid arthritis

作　　者：邓娟[1] 裴必伟[1] 徐胜前[1] 刘童[1] 陈晨[1] 徐建华[1] 

机构地区：[1]安徽医科大学第一附属医院风湿科,合肥230022

出　　处：《中华风湿病学杂志》2012年第10期674-678,共5页Chinese Journal of Rheumatology

摘　　要：目的探讨类风湿关节炎（RA）患者全身骨质疏松和局部骨侵蚀的相关性。方法采用双能x线骨密度测定仪（DEXA）法测定120例RA患者和120名健康者的股骨（股骨颈、Ward区、大转子）和腰椎（腰椎2-4）部位骨密度，详细记录RA患者各临床及实验室指标，并对其中76例RA患者的双手x线进行Sharp评分。采用t检验和r检验进行统计学分析。结果①和健康对照组相比，RA患者在总股骨区、腰椎2、3、4和腰椎2~4部位骨密度明显降低（P〈0．01），而股骨颈、Ward和大转子区骨密度在2组间差异无统计学意义（P〉0．05）。②RA组骨质疏松发生率34．2％（41／120）明显高于健康对照组15．0％（18／120）（χ^2=11．889，P=0.001）。③RA患者中无骨质疏松和有骨质疏松组间在年龄[（49±11）与（58±13）岁，t=5．437，P〈0．01]、健康状况问卷（HAQ）（1．4±0．7与1．7±0．7，t=2．067，P=0．041）、X线关节间隙狭窄评分（24±23与43±32，t=2．705，P=0．010）、X线骨侵蚀评分（20±24与41±36，t=2．786，P=0．008）、Sharp评分（43±47与84±66，t=2．821，P=0．007）上差异有统计学意义，而其他临床及实验室指标在2组间差异无统计学意义（P〉0．05）。④相关性分析显示：RA患者各部位骨密度（总的腰椎2-4部位骨密度除外）均与Sharp评分呈负相关（P〈0．05）。Logistic回归分析发现：年龄（OR=1．069，P=0．012，95％CI：1．015。1．125）和Sharp评分（OR=1．022，P=0．003，95％CI：1．007-1．037）为RA患者发生骨质疏松的危险因素，使用改善病情抗风湿药（OR=0．172，P=0．041，95％CI：0．032～0．930）是RA患者发生骨质疏松的保护因素。结论RA患者骨密度明显降低，其骨质疏松发生率明显升高，且与年龄和局部骨侵蚀密切相关。Objective To investigate the relationship between the general osteoporosis and local bone erosion in patients with rheumatoid arthritis （RA）. Methods Bone mineral density （BMD） of femur （femur neck, Ward area, greater troehanter） and lumbar spine 2-4 （L2-4） by dual energy X-ray absorptiometry was measured in 120 patients with RA and 120 normal controls. All the clinical and laboratory factors of RA were recorded in details, and the radiographic changes in both hands of 76 RA patients were assessed by Sharp＇ method. Statistical anylysis was carried out by using t test andχ^2test. Results ① Compared with normal controls, the BMD of total femur, L2. L3, L4 and L2-4 decreased significantly （P〈0.01）, while there was no significant differences in the BMD of femur neck, Ward area and greater trochanter between the two groups （P〉0.05）. ② The incidence of osteoporosis in RA （34.2%） was higher than that in normal controls （15.0%） χ^2=11.889, P=0.001 ）. ③Patients with osteoporosis had elder age, higher scores of HAQ, higher scores of space narrowing and bone erosion of joint by X-ray＇ Sharp method than those of patients without osteoporosis. There were no significant differences in the changes of other clinical and laboratory parameters between the two groups（P〉0.05）. ④ BMD of total femur, femur neck, Ward area, greater trochanter, L2, L3, L4 correlated with Sharp scores in RA and had shown a negative correlations（P〈0.05）. Logistic regression analysis showed that age（OR=1.069, P=-0.012, 95%CI[ 1.015-1.125） and Sharp scores（OR=1.022, P=-0.003, 95%CI： 1.007- 1.037） were risk factors for osteoporosis in RA patients, but treating with DMARD （OR=0.172, P=0.041, 95%CI： 0.032-0.930） was a protective factor for osteoporosis in patients with RA. Conclusion The BMDdecreases significantly and correlates with age and local bone erosion in patients with RA, while the incidence of osteoporsis increases remarkably.

关 键 词：关节炎 类风湿 骨质疏松 Sharp评分 

分 类 号：R580[医药卫生—内分泌]