运动对类风湿关节炎伴骨质疏松患者的骨密度及骨代谢的影响  

Effects of exercise on bone mineral density and bone metabolism in rheumatoid arthritis patients with osteoporosis

作　　者：欧阳辉[1] 何雪常 沈龙彬 周毅[2] 李朝霞[2] 陈卓铭[1] 

机构地区：[1]暨南大学附属第一医院康复科,广东广州510630 [2]暨南大学附属第一医院风湿免疫科,广东广州510630

出　　处：《中国骨质疏松杂志》2018年第2期174-180,共7页Chinese Journal of Osteoporosis

基　　金：广东省自然科学基金(2015A030313332);广东省中医药局科研课题(20171073);广州市临床医学研究与转化中心试点建设项目(201508020004)

摘　　要：目的探讨类风湿关节炎(rheumatoid arthritis,RA)患者骨密度(bone mineral density,BMD)及骨代谢指标的相关影响因素,观察运动频率对RA伴发骨质疏松(osteoporosis,OP)患者BMD及骨代谢指标的影响。方法回顾性分析45例初诊RA患者的性别、年龄、病程、超敏C反应蛋白(high-sensitivity C-reactive protein,HS-CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、抗环瓜氨酸肽抗体(anti-cyclic cirullinated peptide antibodies,抗CCP抗体)、RA疾病活动性评分(DAS28评分)等指标,观察这些临床因素对RA患者的BMD及血清骨代谢指标的影响。血清骨代谢指标包括β-胶原降解产物(β-C-terminal telopeptide region of collagen type1,β-CTX)、总Ⅰ型胶原氨基端延长肽(I pro collagen N-terminal pro peptide,PINP)、骨钙素(osteocalcin,OC)、25羟维生素D[25-(OH)D],通过电话回访RA患者的康复运动情况,分析运动频率对RA伴OP患者骨密度及骨代谢指标的影响。结果本组RA伴发OP的发生率为46.67%,BMD的下降以腰椎、股骨颈最明显。BMD的改变与年龄、病程、DAS28评分相关,随着年龄的增长、病程的延长、DAS28评分的升高,BMD降低(P<0.05)。骨吸收指标β-CTX在年龄≤65岁组、病程≤0.5年组、抗CCP抗体阳性组均升高,差异有统计学意义(P<0.01,P<0.05);骨形成指标PINP、OC在年龄≤65岁组、抗CCP抗体阳性组均升高,差异有统计学意义(P<0.05);25-(OH)D水平在DAS28评分<2.6组高于DAS28评分≥2.6组,差异有统计学意义(P<0.05)。RA伴OP患者中,经常运动组的全身及腰椎BMD、PINP、OC均高于不运动组,差异有统计学意义(P<0.05,P<0.01);PINP、OC与经常运动呈正相关(P<0.05),β-CTX与抗CCP抗体呈正相关(P<0.01)。多元线性回归分析显示全身BMD受血清25-(OH)D水平及运动频率影响明显,随着血清25-(OH)D水平及运动频率的提高,全身BMD呈增加趋势。结论 RA伴发OP的发病率高,骨密度与年龄、病程、疾病的活动、25-(OH)D水平、Objective To study the influencing factors of bone mineral density（ BMD） and bone metabolism in rheumatoid arthritis（ RA） patients and to evaluate the influence of exercise frequency on BMD and bone metabolism in RA patients with osteoporosis（ OP）. Methods Retrospective analysis of BMD and serum bone metabolism index（ β-CTX,PINP,OC,25-OHD）of 45 RA patients at the first diagnosis,and the influence of gender,age,course of disease,HSCRP,ESR,anti-CCP,DAS28 score and other relevant clinical factors. Data on rehabilitation exercise of RA patients with OP were collected via telephoneinterview and the influence of exercise frequency on their BMD and bone metabolism index was evaluated. Results The incidence rate of RA with OP was 46. 67%,and the most obvious decrease of BMD occurred at lumbar vertebra and femur neck. BMD was related to age,the course of disease and DAS28 score. BMD decreased with age,the course of disease and higher DAS28 score（ P〈0. 05）. Bone absorption index β-CTX increased in those aged ≤65 years,those with the course of disease ≤0. 5 year and those with positive anti-CCP,and the differences were statistically significant（ P〈0. 01,P〈0. 05）. Bone formation index PINP and OC increased in those aged ≤65 years and those with positive anti-CCP,and the differences were statistically significant（ P〈0. 05）.Serum 25-OHD level in the DAS28 score 2. 6 group was higher than that in the DAS28 score ≥2. 6 group,and the difference was statistically significant（ P〈0. 05）. In RA patients with OP,BMD of whole body and lumbar vertebra,PINP and OC in the frequently exercise group were all higher than the no exercise group,and the differences were statistically significant（ P〈0. 05,P〈0. 01）. PINP,OC and frequent exercise had positive correlation（ P〈0. 05）,and β-CTX and anti-CCP had positive correlation（ P〈0. 01）. Multiple linear regression analysis showed that serum 25-OHD level and exercise frequency were significant predictors of whole body BMD,wit

关 键 词：类风湿关节炎 骨质疏松 骨密度 骨代谢标志物 运动 

分 类 号：R593.22[医药卫生—内科学] R589.5[医药卫生—临床医学]