少肌症、维生素D缺乏在类风湿性关节炎合并脊柱骨质疏松性骨折中的临床研究  

Clinical research of sarcopenia and vitamin D deficiency in patients with rheumatoid arthritis and spinal osteoporotic fractures

作　　者：龚勋[1] 徐胜前[1] 刘文[1] 吴颖[1] 齐姗[1] 麻璨琛 肖会[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,安徽合肥230022

出　　处：《中国骨质疏松杂志》2017年第2期221-226,共6页Chinese Journal of Osteoporosis

摘　　要：目的探讨少肌症和维生素D缺乏在RA患者脊柱骨质疏松性骨折(OPF)中的临床意义。方法入选936例RA患者和158例年龄、性别相匹配的正常健康者,所有入选对象均摄脊柱正侧位X线片(T5-L5),并以半定量(SQ)法作为判断脊柱OPF的标准,其中648例RA患者和对照组采用DXA法测定了腰椎和髋部骨密度(BMD),267例RA患者和156例对照组以生物电阻抗法测定了四肢骨骼肌质量,化学发光法测定了234例RA患者和68例对照组血清25(OH)D水平,同时详细记录RA患者各临床及实验室指标等情况。结果 1RA患者中(141/936,15.1%)OPF的发生率明显高于对照组(6/158,3.8%)(χ2=18.658,P<0.0001);少肌症的发生率明显高于对照组(55.8%,149/267 vs 9.0%,14/156,χ2=91.176,P<0.0001);RA组血清25(OH)D水平明显低于对照组[(13.41±9.71)ng/m L,(22.40±6.26)ng/m L,t=9.063,P<0.0001],维生素D缺乏发生率明显高于对照组[80.8%(189/234)vs 36.8%(25/68),χ2=49.412,P<0.0001]。2RA患者OPF组25(OH)D水平明显低于无OPF组[(12.28±5.67)ng/m L vs(17.16±10.90)ng/m L,t=2.600,P=0.01];各部位肌肉量均明显低于无OPF组(P<0.01~0.05)。3线性相关分析发现:RA患者的25(OH)D与骨骼肌、右上肢、左上肢和躯干肌肉量呈正直线相关关系(P<0.05);RA患者的骨骼肌质量与髋部、腰椎各部位BMD呈正直线相关关系(P<0.05)。4多元回归分析显示:女性、HAQ积分和总髖部OP的发生为RA患者发生少肌症的危险因素;年龄为RA患者发生脊柱OPF的危险因素,骨骼肌质量指数(SMI)为RA患者发生脊柱OPF的保护因素。结论 RA患者具有高于正常健康者脊柱OPF的发生率,其25(OH)D水平缺乏普遍存在,少肌症发生率增高;RA患者维生素D缺乏、少肌症与RA患者脊柱OPF的发生密切相关。Objective To explore the effect of vitamin D deficiency and sarcopenia on osteoporotic fracture（OPF） in patients with rheumatoid arthritis（RA）.Methods Nine-hundred and thirty-six patients with RA and 158 normal subjects（as controls）were enrolled.Anteroposterior and lateral X-rays scanning of vertebral column（T5-L5） were conducted for every individual and semi-quantity method was used as the standard for determining vertebral OPF.Bone mineral density（BMD） of the hip and lumbar vertebrae 2-4 in 648 RA and all the controls was detected with DEXA.Skeletal muscle mass of 267 cases and 156 controls was measured with the method of biological electrical impedance.Serum levels of 25-hydroxy vitamin D（25（OH） D） were examined using electro-chemiluminescence in 234 RA patients and 68 normal subjects.Meanwhile,clinical and laboratory index of the patients were recorded in details.Results（1） The prevalence of vertebral OPF in RA patinets was 15.1%（141/936）,which was higher than that in control group（6/158,3.8%,χ~2= 18.658,P 〈0.0001）.The total prevalence of sarcopenia in RA patients determined by skeletal muscle mass in limbs was 55.8%（149/261）,it was apparently higher than that in control group（9.0%,14/156,χ~2=91.176,P〈0.0001）.Compared to those in control group,RA patients had lower serum 25（OH） D levels（22.40 ± 6.26 ng/mL vs.13.41 ±9.71 ng/mL,t=9.063,P〈0.0001） and higher incidence of vitamin D deficiency（36.8%,25/68 vs 80.8%,189/234,χ~2 =49.412,P〈0.0001）.（2） Compared to those with RA but without OPF,patients with OPF had lower serum 25（OH） D levels（17.16 ± 10.90 ng/mL vs.12.28 ±5.67 ng/mL,t=2.600,P=0.01） and lower skeletal muscle mass at each detected site（P 〈0.01-0.05）.（3） Linear correlation analysis showed that skeletal muscle mass was positively correlated with serum 25（OH）D levels and BMD at the femurs and lumbar vertebrae in RA（P 〈 0.05）.（4） Logistic regression analysis（LR Backward） showed that female gender

关 键 词：类风湿关节炎 骨质疏松性骨折 少肌症 25羟维生素D 

分 类 号：R68[医药卫生—骨科学]