类风湿关节炎并发骨质疏松症使用唑来膦酸治疗疗效  

Effect of zoledronic acid treatment in patients with rheumatoid arthritis complicated with osteoporosis

作　　者：王芳[1] 陈真[1] WANG Fang;CHEN Zhen(Department of Rheumatology,The Second Affiliated Hospital of Fujian Medical University,Quanzhou 362000,Fujian,China)

机构地区：[1]福建医科大学附属第二医院风湿免疫科,福建泉州362000

出　　处：《中华临床免疫和变态反应杂志》2021年第3期264-269,共6页Chinese Journal of Allergy & Clinical Immunology

摘　　要：目的探讨类风湿关节炎(rheumatoid arthritis,RA)对于骨质疏松治疗的影响。方法回顾性分析57例在福建医科大学附属第二医院就诊,使用唑来膦酸治疗的骨质疏松症(osteoporosis,OP)患者,评估用药前及用药后1年的腰椎和全髋骨密度(bone mineral density,BMD)情况。根据是否并发RA分为RA组(18例)和非RA组(39例),比较治疗前后BMD的变化值。结果RA组治疗后的腰椎BMD(0.7382±0.1162)g/cm^(2)较治疗前(0.7072±0.1272)g/cm^(2)明显提高(P=0.0004),全髋BMD(0.6493±0.1168)g/cm^(2)较治疗前(0.6439±0.1124)g/cm^(2)无明显变化(P=0.146),非RA组治疗后的腰椎BMD(0.7338±0.1751)g/cm^(2)和全髋BMD(0.7106±0.1256)g/cm^(2)均较治疗前[(0.7236±0.1805)g/cm^(2),(0.7033±0.1307)g/cm^(2)]明显提高(P=0.0258,P=0.0129)。RA组患者用药后腰椎BMD增加量较非RA组明显增多(t=-2.572,P=0.013),全髋BMD的增加量无显著差异(t=0.380,P=0.705)。RA组中,有糖皮质激素治疗史患者与无糖皮质激素治疗史患者比较,腰椎和全髋BMD的增加量均无显著差异(P>0.05)。结论RA并发OP患者较单纯OP患者使用唑来膦酸的疗效更佳,控制RA病情活动有助于OP的治疗。Objective To explore the effect of zoledronic acid treatment in patients with rheumatoid arthritis(RA)complicated of osteoporosis.Methods A retrospective analysis was performed on the lumbar spine and total hip bone mineral density(BMD)of 57 osteoporosis patients treated with zoledronic acid in the Second Affiliated Hospital of Fujian Medical University,including BMD before and 1 year after treatment.Patients were divided into RA group(n=18)and non-RA group(n=39),according to whether combined with RA.The changes of BMD before and after treatment were compared.Results In the RA group,BMD of lumbar spine were significantly improved after treatment[(0.7382±0.1162)g/cm^(2),(0.7072±0.1272)g/cm^(2),P=0.0004].However,there was no significant change in BMD of total hip[(0.6493±0.1168)g/cm^(2),(0.6439±0.1124)g/cm^(2),P=0.146]The BMD of lumbar spine[(0.7338±0.1751)g/cm^(2),(0.7236±0.1805)g/cm^(2)]and total hip[(0.7106±0.1256)g/cm^(2),(0.7033±0.1307)g/cm^(2)]were significantly improved after treatment in the non-RA(P=0.0258,P=0.0129).The increase of BMD in the lumbar spine was significantly higher in the RA group than in the non-RA group(t=-2.572,P=0.013),but there was no significant difference in the increase of BMD in the total hip(t=0.380,P=0.705).There was no significant difference in the increase of BMD in the lumbar spine and total hip of the RA group with and without the history of glucocorticoid therapy(P>0.05).Conclusions Zoledronic acid was more effective in osteoporosis patients with RA than in those without.Controlling disease activity in RA is conducive to the treatment of osteoporosis.

关 键 词：类风湿关节炎 骨质疏松症 唑来膦酸 骨密度 

分 类 号：R58[医药卫生—内分泌]