强直性脊柱炎合并髋关节累及患者骨质疏松症发病概况及相关因素分析  

Prevalence and risk factors of osteoporosis in hip ankylosing spondylitis patients

作　　者：TanChing-Yuan 戴岷[1] 谈裔 胡大伟[1] 

机构地区：[1]上海交通大学医学院附属仁济医院风湿科,上海200001

出　　处：《中国骨质疏松杂志》2017年第7期856-859,共4页Chinese Journal of Osteoporosis

基　　金：上海市重点学科建设项目(T0203);上海市临床医学中心211项目

摘　　要：目的研究强直性脊柱炎(ankylosing spondylitis,AS)合并髋关节累及患者骨质疏松症的发病概况、特点及相关因素。方法收集有髋关节受累的AS患者82例,并以80名健康体检者作为对照。收集患者的临床资料,包括胸腰椎及骨盆X线、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白水平(C-reactive protein,CRP)、HLA-B27、强直性脊柱炎疾病活动指数(bath ankylosing spondylitis disease activity index,BASDAI)、强直性脊柱炎Bath功能指数、强直性脊柱炎放射学指数及治疗情况等。双能X线检测骨密度(bone mineral density,BMD),测量部位为腰椎1~4和股骨颈部位。结果 AS合并髋关节累及的患者骨量减少或骨质疏松发生率(78.05%)明显高于健康对照组(32.5%);与正常对照组比较,AS组表现出更高的骨量减少(46.3%VS 27.5%)和骨质疏松发生率(31.7%VS 5.0%)。但AS患者骨密度检测率及抗骨质疏松治疗率极低。合并髋关节受累的AS患者腰椎及股骨颈部位骨密度水平均明显低于正常对照组。相关性分析结果显示,ESR升高是AS患者腰椎骨丢失的危险因素;而身高、体重、BASDAI及CRP水平与股骨颈部位骨密度明显相关。结论 AS合并髋关节累及患者腰椎及股骨颈部位骨密度水平均明显降低;ESR及CRP水平升高、高疾病活动度是AS患者骨丢失的危险因素;AS合并髋关节累及患者骨质疏松发生率高,但骨密度检测率及抗骨质疏松治疗率极低。Objective The aim of this study was to investigate the prevalence and risk factors of reduced bone mineral density（BMD） in patients with hip joint-involved ankylosing spondylitis（AS）.Methods Eighty-two AS patients with hip joint involvement and eighty healthy controls were enrolled.The clinical data of AS patients were collected.The data included thoracic and lumbar X-rays,erythrocyte sedimentation rate（ESR）,the C-reactive protein（CRP） levels,HLA-B27,Bath ankylosing spondylitis disease activity index（BASDAI）,Bath ankylosing spondylitis metrology index（BASMI）,Bath ankylosing spondylitis functional index（BASFI）,etc.BMD of the lumbar vertebrae（L1-4） and the femoral neck was measured using dual-energy X-ray absorptiometry（DEXA）.Results The incidence of osteoporosis or osteopenia was 78.05% in AS patients with hip involvement and it was significantly higher than that in the normal control group（32.5%）.Compared with the normal controls,AS patients showed higher incidences of osteopenia（46.3% vs.27.5%） and osteoporosis（31.7% vs.5%）.However,the rate of BMD measurement and anti-osteoporosis treatment in patients with AS were extremely low.The BMD level of the lumbar and femoral neck in AS patients with hip involvement was significantly lower than that in the normal control group.Correlation analysis showed that bone loss in the lumbar spine was associated with higher ESR levels and low hip BMD was associated with the height,weight,BASDAI,and CRP levels.Conclusion BMD of the lumbar and femoral neck in AS patients with hip involvement decreased significantly.The increased ESR and CRP levels,and high disease activity are the risk factors for bone loss in AS patients.The prevalence rate of osteoporosis in AS patients is very high,but he rate of BMD measurement and anti-osteoporosis treatment are extremely low.

关 键 词：强直性脊柱炎 骨质疏松 骨密度 髋关节 

分 类 号：R593.23[医药卫生—内科学]