初发结缔组织病患者低骨量及其相关危险因素分析  

Prevalence and possible risk factors of low bone mineral density in untreated patients with connective tissue diseases

作　　者：冯秀媛[1] 莫凌菲[1] 俱博苗 安琪[1] 吕晓虹[1] 何岚[1] 孙怡宁[1] 

机构地区：[1]西安交通大学第一附属医院风湿免疫科,西安710061

出　　处：《中国骨质疏松杂志》2016年第7期809-814,共6页Chinese Journal of Osteoporosis

摘　　要：目的探讨初发结缔组织病患者低骨量的发生率,分析骨量减低的相关危险因素。方法共纳入初发结缔组织病患者726例,其中系统性红斑狼疮127例,类风湿关节炎232例,多发性肌炎/皮肌炎84例,系统性硬化45例,混合性结缔组织病70例,原发性干燥综合征69例,系统性血管炎99例。采用双能X线法测定患者腰椎和髋部骨密度,分别分析腰椎和髋部低骨量与年龄、体重指数、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、25-羟基维生素D、骨钙素、Ⅰ型胶原C端交联肽的相关性。结果 726例患者平均年龄46.9±16.3岁,平均病程49.4±84.1月,体重指数21.27±4.35 kg/m2,绝经后女性占47.7%,骨量减低的发生率为35.5%,骨质疏松发生率为25.2%。患者年龄、总胆固醇、低密度脂蛋白与腰椎骨量显著负相关(r=-0.179,P=0.000;r=-0.113,P=0.011;r=-0.096,P=0.037);血清高密度脂蛋白与腰椎骨量显著正相关(r=0.144,P=0.003);年龄与髋部骨量呈显著负相关(r=-0.156,P=0.000)。结论血清总胆固醇和低密度脂蛋白增高可能是结缔组织病患者腰椎骨量减低的危险因素,高龄是结缔组织病患者腰椎和髋部低骨量的危险因素。Obje ctive To investigate the prevalence and possible risk factors of lowbone mineral density（ BM D） in untreated patients with connective tissue diseases（ CTD）. Me thods A total of 726 untreated patients with CTD were included： 127 patients with systemic lupus erythematosus,232 patients with rheumatoid arthritis,84 patients with polymyositis / dermatomyositis,45 patients with systemic sclerosis,70 patients with mixed connective tissue disease,69 patients with primary Sjogren syndrome,and99 patients with systemic vasculitis. BM D was measured at lumbar spine and at hip with dual-energy X-ray absorptiometry（ DXA）.Osteoporosis was defined as a T score less than- 2. 5 standard deviations（ SD） and osteopenia as a T score less than- 1. 0 SD in at least one region of measurements. The associations between decreased BM D and age,bone mass index,total cholesterol（ TC）,triglyceride,lowdensity lipoprotein cholesterol（ LDL-c）,high density lipoprotein cholesterol（ HDL-c）,25- hydroxyvitamin D（ 25[OH]D）,osteocalcin（ OC）,and C-terminal cross-linking telopeptide of type I collagen（ CTX） were analyzed. Results The mean age of the 726 patients was 46. 9 ± 16. 3 years. The mean disease duration was 49. 4 ± 84. 1 months. The body mass index（ BM I） was 21. 27 ± 4. 35 kg / m^2. There were 47. 7% of postmenopausal women. The incidence of osteopenia and osteoporosis was 35. 5% and 25. 2%,respectively. Age,TC,and LDL-c were negatively correlated with BM D of the lumbar spine（ r =- 0. 179,P = 0. 000; r =- 0. 113,P = 0. 011; r =- 0. 096,P = 0. 037）. HDL-c was positively correlated with BMD of the lumbar spine（ r = 0. 144,P = 0. 003）. Age was negatively correlated with BM D of the hip（ r =- 0. 156,P = 0. 000）.Conclusion The increase of TC and LDL-c may be important risk factors for lowBM D at the lumbar spine. The increase of age may be a risk factor for lowBM D of both the lumbar spine and hip in untreated CTD patients.

关 键 词：结缔组织病 骨密度 骨量减低 骨质疏松 总胆固醇 低密度脂蛋白 高密度脂蛋白 

分 类 号：R68[医药卫生—骨科学]