类风湿关节炎患者继发骨质疏松症高危因素的Meta分析  

High-risk factors of secondary osteoporosis in patients with rheumatoid arthritis: a Meta analysis

作　　者：梁美娥[1] 张莉芸[1] 许珂[1] 张改连[1] 任丽民 

机构地区：[1]山西医学科学院山西大医院风湿免疫科,太原030032

出　　处：《中国药物与临床》2017年第9期1265-1268,共4页Chinese Remedies & Clinics

基　　金：国家自然科学基金(81202356)

摘　　要：目的系统性评估类风湿关节炎(RA)患者继发骨质疏松症(OP)的高危因素,为临床上防治RA继发OP提供理论依据。方法检索2010年1月至2017年6月国内外公开发表的有关于RA继发OP高危因素分析的相关回顾性队列研究。由2名评价者对所纳入的相关文献的研究质量进行共同评价。使用RevMan5.3软件进行数据处理。结果本研究共析共纳入了15篇文献,合计样本量1 996例,其中OP组639例,非OP组1 357例。Meta分析结果提示,RA患者的年龄[WMD=8.61,95%CI(6.26,10.95),P<0.01]、病程[WMD=3.51,95%CI(1.98,5.04),P<0.01]、健康状况问卷(HAQ)[WMD=0.46,95%CI(0.20,0.72),P=0.0005]、双手X线Sharp评分[WMD=38.21,95%CI(10.58,65.84),P=0.007]、红细胞沉降率(ESR)[WMD=8.39,95%CI(2.82,13.96),P=0.003]、C-反应蛋白(CRP)[WMD=7.95,95%CI(2.46,13.45),P=0.005]以及DAS28疾病活动评分[WMD=0.31,95%CI(0.08,0.55),P=0.009]在2组间差异有统计学意义(P<0.05),而患者是否服用糖皮质激素以及患者的类风湿因子(RF)滴度2组间差异无统计学意义(P>0.05)。结论 RA患者高龄、病程长、Sharp评分、炎性指标ESR、CRP以及DAS28评分增高是其继发OP的高危因素,而患者是否服用糖皮质激素以及RF滴度高低与患者是否易继发OP相关性不大。Objective To systematically evaluate the risk factors of secondary osteoporosis （OP） in patients with rheumatoid arthritis （RA）, and to provide a theoretical basis for the clinical prevention and treatment of RA. Methods A retrospective cohort study was conducted to investigate the articles on high-risk factors of RA secondary OP published at home and abroad between January 2010 and June 2017. The quality of the included articles was e-valuated by two evaluators. Rev-Man 5.3 software was used for data processing. Results A total of 15 articles were included and analyzed in the study. The total sample size was 1996 cases, including 639 in the OP group and 1357 in the non-OP group. The findings of the meta analysis suggested that there were statistically significant difference in the age of RA patients [WMD=8.61, 95% CI（6.26, 10.95）, P〈0.01], duration of disease [WMD=3.51, 95% CI（1.98, 5.04）, P〈0.01], health questionnaire （HAQ） [WMD=0.46, 95% CI（0.20, 0.72）, P=0.0005], hands X-ray sharp score [WMD=38.21, 95% CI （10.58, 65.84）, P=0.007], erythrocyte sedimentation rate （ESR） [WMD=8.39, 95%CI （2.82, 13.96）, P=0.003）, C-reactive protein （CRP） [WMD=7.95, 95% CI（2.46, 13.45）, P=0.005] and DAS28 disease activity score [WMD=0.31, 95% CI（0.08, 0.55）, P=0.009] between the two groups. There were no statistically significant dif-ferences in whether the patients taking glucocorticoid （GC） and the drop degrees of rheumatoid factors （RF） between the two groups （P〉0.05）. Conclusion The advanced age, long duration of disease, and increased Sharp score and in-flammatory indexes ESR and CRP and DAS28 scores are the risk factors of secondary OP in RA patients. Whether the patients taking GC and the RF drop degree are not significantly correlated with secondary OP.

关 键 词：关节炎 类风湿 骨质疏松 高危因素 META分析 

分 类 号：R580[医药卫生—内分泌] R593.22[医药卫生—内科学]