男性类风湿关节炎患者骨量减低的相关研究  

Correlation study on osteopenia or osteoporosis in male patients with rheumatoid arthritis

作　　者：安晋宇[1] 文会龙[1] 高立波[1] 方晓辉[1] 李桂军[1] 高磊[1] 吴一雄[1] 胡辉东[1] AN Jinyu;WEN Huilong;GAO Libo;FANG Xiaohui;LI Guijun;GAO Lei;WU Yixiong;HU Huidong(Department of Orthopedics, Changzhou Cancer Hospital of Soochow University, Changzhou 213000, China)

机构地区：[1]苏州大学附属常州市肿瘤医院骨科,江苏常州213000

出　　处：《中国骨质疏松杂志》2020年第8期1163-1166,1179,共5页Chinese Journal of Osteoporosis

摘　　要：目的探讨男性类风湿关节炎(rheumatoid arthriti,RA)患者骨量减低的相关情况及合并骨质疏松的危险因素。方法收集2013年8月至2019年5月在苏州大学附属常州市肿瘤医院诊治的男性类风湿关节炎患者38例,年龄(64.39±9.44)岁,对照组为40例健康正常人群,年龄(63.53±8.14)岁。通过双光能X线骨密度仪测定正位腰椎(L1~4)及左侧股骨近端(包括FN、Troch、Ward、Total)骨密度;运用电化学发光免疫分析法检测BAP、BGP、CTX;记录RA患者的ESR、CRP、关节肿胀及压痛数、RF以及CCP等情况。分析比较两组骨密度及骨生化指标的差异,并采用单因素分析和多因素Logistic回归分析调查类风湿关节炎患者合并骨质疏松的危险因素。结果两组间年龄、体质量指数(body mass index,BMI)差异无统计学意义(P>0.05)。类风湿关节炎组左侧股骨颈、整体髋骨BMD测量值较对照组减低(P<0.05);且类风湿关节炎组骨量减少、骨质疏松发生率较对照组显著增高(P<0.05);在骨生化指标方面,类风湿关节炎组CTX水平高于对照组(P<0.05)。单因素分析显示BMI、CRP、DAS28-ESR及CTX与男性类风湿关节炎患者继发骨质疏松相关(P<0.05);多因素Logistic回归分析显示,BMI<18.5 kg/m^2(OR=0.014),DAS28-ESR>5.1(OR=21.433)及CTX>0.7 ng/mL(OR=25.875)是男性类风湿关节炎继发骨质疏松的独立危险因素(P<0.05)。结论男性类风湿关节炎患者同样易合并骨质疏松的发生,BMI、DAS28及CTX等危险因素应高度重视。Objective To investigate the osteopenia or osteoporosis in rheumatoid arthritis focused on male patients and the risk factors.Methods Seventy-eight cases who attended in our hospital from August 2013 to May 2019 were selected,including 38 patient(64.39±9.44 years old)with rheumatoid arthritis and 40 healthy normal people(63.53±8.14 years old).The lumbar spine(L1-4)and left femoral neck(FN),femoral trochanter(Troch),the Ward’s triangle(Ward’s)and total hip(Total)BMD were detected by DXA;the levels of BAP,BGP and CTX were determined by electrochemiluminescence immunoassay.The ESR,CRP,number of swollen joints and tender joint count,RF and CCP of patients with rheumatoid arthritis were examined.The differences in bone mineral density and bone biochemical indexes between the two groups were analyzed and compared.,Single factor and multivariate Logistic regression analysis were used to indentify risk factors for osteoporosis in patients with RA.Results There was no significant difference in age and body mass index(BMI)between the two groups(P>0.05).The frequency of osteopenia or osteoporosis among male patients with RA was significantly higher than that among controls(P<0.05)and RA patients had a significantly lower femoral neck and total hip BMD than health individuals(P<0.05).The CTX levels in RA group was higher than control group(P<0.05).Single analysis indicated 4 factors associated with osteoporosis in male patients with RA,including BMI,CRP,DAS28-ESR and CTX.In multivariable logistic regression models,BMI<18.5 kg/m^2(OR=0.014),DAS28-ESR>5.1(OR=21.433)and CTX>0.7 ng/mL(OR=25.875)were the independent risk factors for osteoporosis at either site in male patients with RA.Conclusion Male patients with RA are prone to osteoporosis,and the risk factors such as BMI,DAS28 and CTX should be highly valued.

关 键 词：类风湿关节炎 骨质疏松 骨密度 骨生化指标 高危因素 

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