强直性脊柱炎患者骨密度变化及应用FRAX评估其骨折危险性的研究  

Study of the changes of bone mineral density in patients with ankylosing spondylitis and the evaluation of fracture risk using FRAX

作　　者：康日辉[1] 薛原[1] 陈君敏[1] 叶德富[1] 郑擎[1] 曾晓虹[1] 

机构地区：[1]福建医科大学附属第一医院风湿血液内科,福州350005

出　　处：《中国骨质疏松杂志》2013年第3期221-225,共5页Chinese Journal of Osteoporosis

摘　　要：目的观察强直性脊柱炎患者骨密度(BMD)的变化以及FRAX评估AS患者10年内发生骨折的概率的情况。方法 AS组:2010年6月～2011年6月,住院的AS患者42例,其中男29例、女13例,男:女=2.2∶1,年龄34.57±13.67岁;健康对照组:40例,其中男27例、女13例,男:女=2.1∶1,年龄32.96±12.58岁。分别检测双股骨颈、腰椎1-4 BMD与T值;AS组患者均检测血清CRP、Ca2+、P3-、ALP含量与ESR;AS组患者双侧骶髂关节做CT扫描并分级;根据FRAX测定两组10年内发生髋部骨折和主要骨质疏松性骨折的概率。统计学方法采用t检验、相关分析、方差检验及χ2检验。结果①AS组男性、女性双股骨颈的BMD值(0.938±0.176,0.942±0.150)明显低于健康对照组(1.180±0.139,1.172±0.123);AS组男性、女性的腰椎1-4 BMD值(1.040±0.183,1.071±0.198)明显低于健康对照组(1.170±0.117,1.181±0.113);②AS组骨质疏松及骨量减少分别是45.24%和66.67%;③AS组双股骨颈、腰椎1-4 BMD与血清Ca2+含量呈正相关性(r=0.435,0.566);④AS组CT第Ⅳ级的双股骨颈BMD值(0.731±0.087)明显低于第Ⅰ、Ⅱ级的值(0.991±0.137,1.002±0.140);而各级腰椎1-4 BMD值差异无统计学意义(P均>0.05);⑤应用FRAX评估AS组10年内的髋部骨折概率明显高于健康对照组(P<0.05)。结论 AS患者存在不同程度的BMD的降低,导致继发性OP或骨量减少,FRAX测评结果显示AS患者10年内发生髋部骨折的危险性明显增加,应引起医生与患者的足够重视,积极采取防治措施。Objective To observe the changes of bone marrow density （BMD） in patients with ankylosing spondylitis （AS） , and to evaluate the probability of bone fracture in 10 years in AS patients using FRAX. Methods Forty-two patients with AS, who were treated from June 2010 to June 2011, were enrolled in AS group. Among them, 29 were male, and 13 were female. The sex ratio （male/female） was 2.2. An average age was 34.57 ± 13.67 years old. Forty patients were involved in control group, including 27 males and 13 females. The sex ratio （male/female） was 2.1. An average age was 32.96 ± 12. 58 years old. BMD and T- value of the lumbar vertebrae （L1-4） and the bilateral femoral neck in both groups were detected. Serum CRP, Ca2＋ , P3- , and ALP of patients in AS group were detected. ESR was also measured. The hips of patients in AS group were scanned and graded with CT scan. The probability of hip fractures and osteoporotic fractures in 10 years in all patients was evaluated using FRAX. All data were analyzed using T-test, analysis of variance, correlation analysis, or χ2-test. Results BMD of the bilateral femoral neck of males and females in AS group was 0. 938 ± 0. 176 and 0. 942 ± 0. 150, respectively, which was significantly lower than that in control group （1. 180 ±0. 139 and 1. 172 ±0. 123）. BMD of L1-4 of males and females in AS group was 1. 040 ± 0. 183 and 1. 071 ±0. 198, respectively, which was significantly lower than that in control group（1. 170 ± 0. 117 and 1. 181 ± 0. 113）. The incidence of osteoporosis and osteopenia in AS group was 45.24% and 66.67% , respectively. BMD of both femoral neck and L1-4 was positively correlated with serum Ca2＋ （r = 0.435, r = 0.566）. BMD of the femoral neck in grade Ⅳ （0.731 _± 0.087） was significantly lower than that of in grade Ⅰ and grade Ⅱ （0. 991 ± 0. 137, 1.002 ± 0. 140）. While no statistical difference was observed in BMD of L1-4. Meanwhile, the probability of the hip fractures in AS group was significantly higher

关 键 词：强直性 脊柱炎 骨密度 FRAX 骨折 危险性 

分 类 号：R68[医药卫生—骨科学]