女性类风湿关节炎患者手腕骨密度检查与超声腕关节骨侵蚀及炎症评分的相关性  

Relationship between wrist bone mineral density and synovitis,erosion by ultrasonography in female rheumatoid arthritis patients

作　　者：王昱[1] 耿研[1] 邓雪蓉[1] 张卓莉[1] 

机构地区：[1]北京大学第一医院风湿免疫科,北京100034

出　　处：《北京大学学报（医学版）》2015年第5期774-780,共7页Journal of Peking University:Health Sciences

基　　金：首都医学发展科研基金(2011-4021-03)资助~~

摘　　要：目的：分析类风湿关节炎（rheumatoid arthritis,RA）患者手腕双能X线（dual-energy X-ray absorptiometry,DXA）检查结果,与关节超声影像学评分比较,以确定其与RA关节炎症以及骨侵蚀的相关性。方法：80名女性类风湿关节炎患者采用双能X线法检测非优势手腕部骨密度（bone mineral density,BMD）以及椎体、髋部骨密度,同时检测同侧以及双侧腕关节超声,扫描桡腕关节、中线腕骨间、尺腕关节,并分别记录腕关节滑膜增生、肌腱炎、骨侵蚀等情况,使用彩色多普勒进行关节炎评分。结果：（1）80名女性RA患者中,平均年龄（54.6±13.3）（27.0∽80.0）岁,病程48（12~116）个月,体重指数（body mass index,BMI）（23.0±4.0）（14.8~31.2）kg/m2。RA患者腕部BMD低于正常对照[（0.297±0.121）vs.（0.420±0.180）g/cm2,P〈0.01]。（2）早期RA腕部骨密度高于长病程RA[（0.326±0.103）vs.（0.285±0.132）g/cm2,P〈0.01],腕部严重骨质疏松发生率低于长病程RA（47.8%vs.64.9%,P〈0.05）,超声发现腕骨侵蚀发生率低于长病程RA（39.1%vs.56.1%,P〈0.01）。（3）高疾病活动度组腕关节骨密度低于中度活动以及缓解患者[（0.267±0.140）g/cm2vs.（0.280±0.126）g/cm2,（0.267±0.140）g/cm2vs.（0.320±0.103）g/cm2],差异均具有统计学意义（P〈0.05）。高疾病活动度组RA患者与中度活动组患者抗环胍氨酸多肽抗体（anti-cyclic citrullinated peptide antibody,ACPA）阳性比例分别为85%和92.6%,均高于缓解组患者81.8%,差异具有统计学意义（P〈0.05）。患者DAS28ESR（disease activity score 28 joint count）与腕部BMD呈负相关（r=-0.288,P〈0.01）。（4）RA患者腕部BMD与脊柱和髋部BMD均呈正相关（r=0.634,P〈0.01,r=0.795,P〈0.01）;腕部BMD与疾病病程呈负相关（r=-0.286,P〈0.01）,与DAS28 ESR呈负相关（r=-0.301,P〈0.01）。早期RA腕部BMD和髋部BMD呈正相关（r=0.95,P〈0.05）,且相关系数较高。（5）骨质疏松组Objective： To find the correlation of wrist bone mineral density（ BMD） to wrist synovitis and erosion,by comparing wrist BMD and ultrasonography. Methods： A number of 80 female RA patients were examined by BMD measurement of the femoral neck,spine and non-dominant wrist using dual-energy X-ray absorptiometry（ DXA）. Synovitis of the wrist was examined by ultrasonography. The wrist joint（ radiocarpal joint,dorsal midline,and carpoulnar joint） was assessed in the same side of DXA,with transverse and longitudinal scans for USGS synovial hypertrophy and proliferation,tenosynovitis,tendinitis and bone erosion. Colour and power doppler ultrasonography（ PDUS） were used to sum the synovitis score. Results： We found：（ 1） In the study,80 female RA patients were enrolled,the mean age was 54. 6 ± 13. 3（ 27. 0- 80. 0） years,the disease duration was 48（ 12- 116） months,and the body Mass Index was 23. 0 ± 4. 0（ 14. 8- 31. 2） kg / m2. The Wrist BMD（ g / cm2） in RA significantly reduced,compared with normal controls（ 0. 297 ± 0. 121 vs. 0. 420 ± 0. 180,P〈0. 01）.（ 2） The Wrist BMD（ g / cm2） exceeded in early RA compared with the established RA（ 0. 326 ± 0. 103 vs. 0. 285 ±0. 132,P〈0. 01）; the positive rate of severe osteoporosis in wrist was lower in early RA compared with the established RA（ 47. 8% vs. 64. 9%,P〈0. 05）; the positive rate of bone erosion in wrist by ultrasound was lower in early RA compared with the established RA（ 39. 1% vs. 56. 1%,P〈0. 01）.（ 3）The wrist BMD（ g / cm2） in RA with high disease activity reduced compared with moderate and low disease activity（ 0. 267 ± 0. 140 vs. 0. 280 ± 0. 126） and（ 0. 267 ± 0. 140 vs. 0. 320 ± 0. 103） respectively,P〈0. 05）. The percentages of positive ACPA in the high and moderate disease activity groups were significantly higher than those in the remission group（ 85% vs. 81. 8% and 92. 6% vs. 81. 8%,respectively）. DAS28 ESR was correlated with wrist BMD（ r =- 0. 288,P〈0

关 键 词：关节炎 类风湿 骨密度 腕关节 吸收测定法 光子 超声检查 

分 类 号：R593.22[医药卫生—内科学]