跌倒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  

Association between balance and falls with spinal osteoporotic fractures in patients with rheumatoid arthritis

作　　者：孙红丽 徐胜前[1] 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》2018年第2期91-95,共5页Chinese Journal of Rheumatology

基　　金：安徽省自然科学基金（1308085MH167）

摘　　要：目的分析跌倒及平衡能力减退对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科386例住院的RA患者和同期158例年龄、性别相匹配的健康人，摄脊柱（T5~L5）正侧位X线片并以半定量（SQ）法作为判断脊柱OPF的标准，其中296例RA患者记录了近1年内跌倒发生情况，263例RA患者采用Berg平衡量表法测定了平衡能力，采用t检验和χ2检验以及Logistic多元回归进行统计分析。 结果① 386例RA患者中有67例发生OPF，发生率为17.4%（67/386），是健康对照组中OPF发生率3.8%（6/158）的4.5倍（χ2=17.743，P〈0.01）。296例RA患者中近1年内有60例发生过跌倒，发生率为20.3%。②发生OPF的RA患者Berg评分明显低于未发生OPF组[（33±15）和（43±14），t=4.150，P〈0.01]；发生跌倒的RA患者Berg评分明显低于未发生跌倒组[（31±16）和（41±14），t=4.373，P〈0.01]。③发生OPF的RA患者中跌倒的发生率为39.2%（20/51），明显高于未发生OPF组中的15.7%（22/140）（χ2=12.036，P=0.01）；RA患者Berg评分〈40分组跌倒的发生率为32.5%（37/114），高于Berg评分≥40分组的12.1%（18/149），差异有统计学意义（χ2=16.212，P〈0.01）。RA患者OPF组的Berg评分〈40分的发生率为68.8%（33/48），明显高于无OPF组的29.7%（35/118），差异有统计学意义（χ2=21.558，P〈0.01）。④ Logistic回归分析发现：年龄[OR=1.064，95%CI（1.025，1.103），P=0.001]和跌倒[OR=2.735，95%CI（1.168，6.407），P=0.021]为RA患者发生脊柱OPF的危险因素，Berg平衡量表评分[OR=0.967，95%CI（0.940，0.993），P=0.012]与RA患者发生脊柱OPF呈负相关。 结论RA患者脊柱OPF的发生与跌倒和平衡能力的减退密切相关。ObjectiveTo investigate the prevalence of balance deficiency and falls in patients with rh-eumatoid arthritis （RA）, and to explore the effect of above factors on osteoporotic fracture （OPF）. MethodsA total of 386 patients with RA and 158 age, gender-matched normal subjects from Jan 2013 to Oct. 2015 were recruited. Antero-posterior and lateral X-rays scanning of vertebral column （T5-L5） were conducted for each individual, and semi-quantity method was used as the standard for determining vertebral OPF. Falls in 296 RA were recorded in details.The balance ability of 263 cases were measured by Berg balance scale. Statistical analysis was performed with ttest and Chi-square text and logistic regression analysis. Results① The prevalence of vertebral OPF in RA was 17.4%（67/386）, which was 4.5 times the prevalence of the control group （6/158, 3.8%） （χ2=17.743, P〈0.01）. The occurrence rate of falls in RA was 20.3% during the last year （60/296）. ② Compared to RA without OPF, patients with OPF had lower Berg balance score （43±14 vs 33±15, t=4.150, P〈0.01）. Patients with falls also had lower Berg balance scale scorethan that in RA without falls （31±16 vs 41±14, t=4.373, P〈0.01）. ③ The prevalence of falls during the last year in RA with vertebral OPF was 39.2% （20/51）, which was higher than that in RA without OPF （15.7%, 22/140） （χ2=12.036, P=0.01）. The prevalence of falls during the last year in RA with Berg balance scale score 〈40 was 32.5%, which was higher than that in patients with Berg balance scale score≥40 （P〈0.01）. Incidence of Berg balance scale score 〈40 in patients with OPF （68.8%, 33/48） was higher than that in group without OPF （29.7%,35/118） （χ2=21.558, P〈0.01）. ④ Logistic regression analysis found that age [OR=1.064, P=0.001, 95%CI（1.025, 1.103）] and falls [OR=2.735, P=0.021, 95%CI（1.168, 6.407）] were risk factors for OPF in RA patients, while Berg balance scale score [OR=0.957, P=0.016, 95%CI（0.924,

关 键 词：关节炎 类风湿 姿势平衡 骨质疏松性骨折 跌倒 

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