类风湿关节炎患者骨质疏松性骨折的临床研究  

Clinical study of osteoporotic fracture in patients with rheumatoid arthritis

作　　者：刘童[1] 徐胜前[1] 邓娟[1] 裴必伟[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免疫科,合肥230022

出　　处：《中华风湿病学杂志》2013年第5期341-345,共5页Chinese Journal of Rheumatology

基　　金：安徽省自然科学基金（1308085MH163）

摘　　要：目的分析住院类风湿关节炎（RA）患者骨质疏松和骨质疏松性骨折（OPF）的发生情况和临床危险因素。方法收集2010--2011年确诊的住院RA患者272例，以x线片作为判断骨折的标准，采用双能量x射线骨密度测量仪（DEXA）测定203例RA患者和120名健康人股骨和腰椎的骨密度，同时详细记录RA患者各临床及实验室指标，并对其中169例RA患者的双手x线进行Sharp评分。采用t检验、Mann．Whitney检验、矿检验和多元Logistic回归进行统计学处理。结果①和健康对照组相比，RA患者在股骨和腰椎部位骨密度均明显降低（P如．01），其骨质疏松发生率32．00／0（65／203）明显高于健康对照组15．0％（18／120）（~=11．442，P=0．001）。272例RA患者中发生OPF的患者33例，发生率为12．1％；OPF组RA股骨区各部位骨密度较无OPF组明显降低（P〈0．01），但腰椎各部位骨密度差异无统计学意义（P〉0．05）。②服用糖皮质激素（GC）的RA患者中骨质疏松发生率为42．2％（46／109），高于未服用GC组中的20．2％（18／89）（X2=10．818，P=0．001）；服用Gc的RA患者中OPF发生率为17．5％（24／137），高于未服用Gc组中的7．2％（9／125）钟=6．321，P=0．012）。③多元Logistic回归分析发现：年龄[D尺=I．050，P=0．001，95％CI（1．020，1．080）]、HAQ[OR=1．966，P=O．031，95％CI（1．064，3．631）]和GC日剂量【OR=1．075，P=O．031，95％C／（1．007，1．148）]为RA患者发生骨质疏松的危险因素；而年龄[OR=1．041，P=0．046，95％CI（1．001，1．084）]和骨质疏松[OR=3．484，P=0．016，95％CI（1．258，9．646）]为RA患者发生OPF的危险因素。结论RA患者骨质疏松和OPF发生率明显升高，且与年龄、RA疾病活动性和局部骨侵蚀、GC的使用密切相关。Objective To-investigate the clinical features and related risk factors of osteoporosis （OP） and osteoporotic fracture （OPF） in patients with rheumatoid arthritis （RA）. Methods Two hundred and seventy- two in-patients with RA between 2010-2011 were surveyed, X-ray was detected for the diagnosis of fracture. Bone mineral density（BMD） of proximal femur and lumbar vertebrae （L2~） in 203 patients were measured by dual energy X-ray absorptio-metry （DEXA）, and the radiographic changes in both hands of 169 RA patients were assessed by Sharp scoring system. All the clinical and laboratory factors of RA were recorded in detail by rheumatologists. The results of 120 normal people were used as controls. T-test, Mann-whitney test, x2 test and Logistic regression were used for statistical analysis. Results （1） Compared to the normal group, the BMDs of RA patients at each measured location were significantly lower （P〈O.O1）, the OP incidence was 32.0% （65/ 203）, which was significantly higher than that of the normal group, which was 15.0% （181120） （X2=11.442, P=0.001 ）. There were 33 cases of OPF among all 272 RA patients, and the occurrence rate was 12.1%. BMDs of the femur in RA with OPF were lower than those in RA without OPF （P〈0.01）. （2） Incidence of OP in RA with glucoco-rticoid was 42.2%（46/109）, which was higher than that in RA without glucocorticoid （20.2%, 18/89） （X2=10.818, P=0.001）. Compared with RA without giucocorticoid, the incidence of OPF in RA with giucocorticoid elevated evidently [7.2% （91125） vs 17.5% （241137）] （Xz=6.321,P=0.O12）. （3） Logistic regression （back-ward LR method） analysis found that the risk factors for OP in RA patients were age [OR=l.050, P=-0.001, 95%CI（1.020, 1.080）~, HAQ [OR=1.966, P=O.031, 95%CI （1.064, 3.631）], and glueocorticoid average daily dosage [OR=1.075, P=O.031, 95%CI （1.007, 1.148）1. The risk factors for OPF in RA patients were age OR=l.041, P=0.046, 95%CI （1.001, 1.084）] and

关 键 词：关节炎 类风湿 骨质疏松 骨折 

分 类 号：R593.22[医药卫生—内科学]