少肌症及平衡能力减退在类风湿关节炎合并脊柱骨质疏松性骨折中的临床研究  

Associations between balance capacity declining and sarcopenia with spinal osteoporotic fracture in patients with rheumatoid arthritis

作　　者：岳璟 徐胜前[1] 孙红丽 刘文[1] 齐姗[1] 吴颖[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,合肥230022

出　　处：《中华风湿病学杂志》2017年第10期667-672,共6页Chinese Journal of Rheumatology

摘　　要：目的探讨少肌症及平衡能力减退对RA患者发生脊柱骨质疏松性骨折（OPF）的影响。方法选择2013年1月至2015年10月安徽医科大学第一附属医院风湿免疫科936例住院的RA患者和同期158名年龄、性别相匹配的健康人，摄脊柱（第5胸椎到第5腰椎）正侧位X线片并以半定量（SQ）法作为判断脊柱OPF的标准，267例RA患者和156名健康对照组以生物电阻抗法测定四肢骨骼肌质量，采用Berg平衡量表法测定RA患者平衡能力。采用SPSS 17.0软件进行统计分析，不同组间率的比较采用χ2检验，不同组间非正态分布计量资料的比较采用秩和检验，两两指标间相关性采用线性相关分析，2项分类资料多元回归分析采用Logistic回归分析[向后逐步回归（Backward LR）法]。结果① 936例RA患者中有141例发生OPF，发生率为15.1%，明显高于健康对照组中OPF发生率3.8%（6/158）（χ2=18.658，P〈0.01）。RA患者少肌症发生率为55.8%（149/267），明显高于对照组（9.0%，14/156，χ2=91.176，P〈0.01）。②RA患者脊柱OPF组的总体和四肢各部位骨骼肌质量均明显低于无脊柱OPF组（P〈0.05）；发生脊柱OPF的RA患者Berg评分为（33±15）也明显低于未发生脊柱OPF组（43±14）（t=4.150，P〈0.01）。③ RA患者少肌症组Berg评分（37±14和43±13，t=3.524，P=0.001）明显低于无少肌症组，BBS≤40分的发生率50.8%（65/128）明显高于无少肌症组29.9%（32/107，χ2=10.477，P=0.001）；RA患者Berg评分≤40分组总体骨骼肌质量（18±4和20±5，t=3.563，P〈0.01）及四肢各部位骨骼肌质量较Berg评分〉40分组明显减低（P〈0.05）。④ RA患者Berg评分与骨骼肌质量指数（SMI）（r=0.299，P〈0.01）、总体骨骼肌质量（r=0.251，P〈0.01）、右上肢肌肉量（r=0.225，P〈0.01）、左上肢肌肉量（r=0.221，P〈0.01）、躯干肌肉量（r=0.230，P〈0.01）、右下肢肌肉量（r=0.228，P〈0.01）、左�Objective To investigate the prevalence of balance capacity declining and sarcopenia in patients with rheumatoid arthritis （RA）, and to explore the effect of balance capacity declining and sarcopenia on spinal osteoporotic fracture （OPF） in RA.MethodsA total of 963 hospitalized patients with RA and 158 age, gender-matched normal subjects from Jan. 2013 to Oct. 2015 were recruited from department of Rheumatology and Immunology, the first affiliated hospital of Anhui Medical University. Anteroposterior and lateral X-ray scanning of vertebral column （T5-L5） was conducted for every individual and semi-quantity method were used as the standard for determining vertebral OPF. Two hundred and sixty-seven RA patients and 156 control individuals were measured by bioelectrical impedance method for detecting skeletal muscle mass. Berg balance scale method was used to determine the balance capacity in RA patients. Statistical analyses were performed using statistical product and service solutions （SPSS） software （Version 17.0）. Comparison of frequency among different groups was used by χ2 test. Ranksum test was used to compare the median of measurement data in different groups when the data were skewed in distribution. Linear correlation between two indicators was represented with correlation coefficient. Multivariate regression was analyzed by binary logistic Regression （Backward LR）.Results① The prevalence of vertebral OPF in RA was 15.1% （141/936）, which was higher than that in the control group （6/158, 3.8%） （χ2=18.658, P〈0.01）. The incidence of sarcopenia in RA patients was 55.8%（149/267）, which was significantly higher than that in control group （9.0%, 14/156） （χ2=91.176, P〈0.01）.②Compared to RA without spinal OPF, skeletal muscle mass of general body and every part of extremities were apparently decreased in RA with spinal OPF （P〈0.05）. Berg balance scale score in RA with spinal OPF （33±15） was lower than that in RA without spinal OPF （43±14） �

关 键 词：关节炎 类风湿 少肌症 平衡能力 骨质疏松性骨折 

分 类 号：R580[医药卫生—内分泌] R593.22[医药卫生—内科学] R683[医药卫生—临床医学]