类风湿关节炎发生骨质疏松骨折影响因素分析  

Influencing Factors of Incidence of Osteoporotic Fractures in Patients with Rheumatoid Arthritis

作　　者：庞琳烜 郑朝晖[1] 杨西超[1] 谢荣华[1] 吴振彪[1] 

机构地区：[1]第四军医大学西京医院临床免疫科,西安710032

出　　处：《解放军医药杂志》2016年第6期69-72,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

摘　　要：目的探讨类风湿关节炎(RA)患者出现骨质疏松骨折(OPF)的影响因素。方法回顾性分析2013年2月—2014年12月于我院确诊118例RA患者临床资料,根据骨质疏松(OP)和OPF发生情况将其分成单纯RA组(A组,n=58),RA继发OP组(B组,n=40)和RA继发OPF组(C组,n=20)。比对3组患者骨密度水平、骨密度T值、血清25-羟基维生素D[25(OH)D]水平、维生素D缺乏率、跌倒率、糖皮质激素应用率、应用剂量及应用时间等指标差异,分析RA患者发生OPF与血清25(OH)D水平、骨密度水平、糖皮质激素非小剂量、长时间应用及跌倒的相关性。结果 B、C组骨密度水平、骨密度T值、血清25(OH)D水平均显著低于A组(P<0.05),维生素D缺乏率、糖皮质激素应用率、非小剂量应用率及长期应用率则均显著高于A组(P<0.05)。C组跌倒率明显高于A、B两组(P<0.05)。RA患者发生OPF与长期、非小剂量应用糖皮质激素及跌倒呈正相关性(P<0.05),与血清25(OH)D和骨密度水平呈负相关性(P<0.05)。结论缺乏维生素D、骨密度降低、长期或非小剂量应用糖皮质激素及跌倒均可增加RA患者发生OPF的风险。Objective To investigate influencing factors of incidence of osteoporotic fractures（ OPF） in patients with rheumatoid arthritis（ RA）. Methods Clinical data of 118 RA patients during February 2013 and December 2014 was retrospectively analyzed,and the patients were divided into only RA group（ group A,n = 58）,RA with secondary OP group（ group B,n = 40） and RA with secondary OPF group（ group C,n = 20） according to the incidence of osteoporosis（ OP） and OPF. Indexes such as bone mineral density（ BMD） level,bone density T value,serum 25-hydroxy-vitamin D [25（ OH） D] level,rates of vitamin D deficiency and falling down,usage rates of glucocorticoid,dosage and usage of time in three groups were compared. The correlations between incidence of OPF and serum 25（ OH） D level,BMD level,non low-dose and long time use of glucocorticoid and falling down in patients with RA were analyzed. Results Compared with those in group A,values of BMD level,bone density T value and serum 25（ OH） D level were significantly lower,while rates of vitamin D deficiency,glucocorticoid usage,non low-dose usage and long time use of glucocorticoid were significantly higher in group B and C（ P〈0. 05）. Rate of falling down in group C was significantly higher than those in group A and B（ P〈0. 05）. Incidence of OPF was positively correlated with long-term and non-small doses of glucocorticoid and falling down in patients with RA（ P〈0. 05）,while it was negatively correlated with serum 25（ OH） D and BMD levels（ P〈0. 05）. Conclusion Vitamin D deficiency,decreased BMD level,long-term or nonsmall doses of glucocorticoid usage and falling down can increase risk of OPF incidence in patients with RA.

关 键 词：维生素D缺乏 糖皮质激素类 关节炎 类风湿 骨质疏松性骨折 

分 类 号：R593.22[医药卫生—内科学]