前臂骨密度对绝经后类风湿关节炎患者骨质疏松的预测价值及其影响因素分析  

Predicting value of forearm bone density on osteoporosis in patients with postmenopausal rheumatoid arthritis and its influencing factors

作　　者：徐琼[1] 张彦 Xu Qiong;Zhang Yan(Department of Endocrinology and Hematology,the Third People′s Hospital of Hangzhou,Hangzhou 310009,China)

机构地区：[1]杭州市第三人民医院内分泌血液科,310009

出　　处：《中国医师进修杂志》2020年第1期30-34,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨前臂骨密度对绝经后类风湿关节炎(RA)患者发生骨质疏松的预测价值及其影响因素。方法回顾性分析杭州市第三人民医院内分泌血液科2016年1月1日至2018年12月31日收治的98例绝经后RA患者的临床资料。采用双能X线骨密度仪(DXA)测量前臂(左侧)和中轴(腰椎和左髋部)骨密度等指标,并采用健康评价表(HAQ)进行评估。探讨中轴骨密度与前臂骨密度的关系,前臂骨密度诊断腰椎和左髋部骨质疏松的最佳T值,以及可能影响前臂骨密度的因素。结果在98例绝经后RA患者中,腰椎骨密度(0.92±0.17)g/cm^2,T值-0.7±0.4;左髋部骨密度(0.80±0.15)g/cm^2,T值-1.2±1.1;前臂骨密度(0.36±0.13)g/cm^2,骨矿含量(0.72±0.23)g/cm,T值-2.3±1.8。中轴骨密度测量结果显示,骨密度正常15例(15.31%),骨密度异常83例(84.69%);腰椎骨密度测量结果显示,骨密度正常36例(36.73%),骨密度异常62例(63.27%);左髋部骨密度测量结果显示,骨密度正常19例(19.39%),骨密度异常79例(80.61%)。前臂骨密度测量结果显示,骨密度正常24例(24.49%),骨密度异常74例(75.51%)。中轴骨密度正常患者与中轴骨密度异常患者、腰椎骨密度正常患者与腰椎骨密度异常患者及左髋部骨密度正常患者与左髋部骨密度异常患者相比,年龄均明显低,前臂骨密度、骨矿含量和T值均明显高,差异有统计学意义(P<0.01或<0.05);体质量指数比较差异无统计学意义(P>0.05)。受试者工作特征曲线分析结果显示,前臂骨密度诊断腰椎骨质疏松的曲线下面积(AUC)为0.842(95%CI 0.795~0.913),最佳T值为-2.46,敏感度为75.00%,特异度为85.48%;前臂骨密度诊断左髋部骨质疏松的AUC为0.849(95%CI 0.802~0.908),最佳T值为-2.32,敏感度为73.68%,特异度为83.54%。前臂骨密度正常患者年龄、病程、HAQ积分明显小于前臂骨密度异常患者[(50.21±11.92)岁比(58.45±14.13)岁、(6.95±2.41)年比(9.73±3.17)年和(1.14±0.36)分比(1.63±0.51)�To explore the predictive value of forearm bone density on osteoporosis in patients with postmenopausal rheumatoid arthritis(RA)and its influencing factors.Methods The clinical data of 98 postmenopausal RA patients in Department of Endocrinology and Hematology,the Third People′s Hospital of Hangzhou from January 1,2016 to December 31,2018 were retrospectively analyzed.The bone density of the forearm(left)and central axis(lumbar spine and left hip)were measured using dual-energy X-ray absorptiometry(DXA),and the score of health assessment questionnaires(HAQ)was evaluated.The relationship between central axis bone density and forearm bone density,the optimal T value of forearm bone density for the diagnosis of lumbar spine and left hip osteoporosis,and the influencing factors of forearm bone density were analyzed.Results In 98 patients with postmenopausal RA,lumbar vertebrae bone density was(0.92±0.17)g/cm^2,and T value was-0.7±0.4;left hip bone density was(0.80±0.15)g/cm^2,and T value was-1.2±1.1;forearm bone density was(0.36±0.13)g/cm^2,bone mineral content was(0.72±0.23)g/cm,and T value was-2.3±1.8.The central axial bone density measurement result showed that normal bone density was in 15 cases(15.31%),and abnormal bone density was in 83 cases(84.69%).The lumbar spine bone density measurement result showed that normal bone density was in 36 cases(36.73%),and abnormal bone density was in 62 cases(63.27%).The left hip bone density measurement result showed that normal bone density was in 19 cases(19.39%),and abnormal bone density was in 79 cases(80.61%).The forearm bone density measurement result showed that normal bone density was in 24 cases(24.49%),and abnormal bone density was in 74 cases(75.51%).The age was significantly younger,the forearm bone density,bone mineral content and T value were significantly higher in patients with normal central axial bone,lumbar spine and left hip bone density,compared with those in patients with abnormal central axial bone,lumbar spine and left hip bone density respec

关 键 词：关节炎 类风湿 绝经期 骨密度 骨质疏松 回顾性研究 

分 类 号：R593[医药卫生—内科学] R5[医药卫生—临床医学]