骨质疏松型膝骨关节炎患者骨代谢及生活质量评估  

Evaluation of bone metabolism and quality of life in patients with osteoporotic knee osteoarthritis

作　　者：胡楠 王沛 张竞[1] 王静[1] 王婧[2] 吴田明 王亚红 李娇 刘小平 张继荣 郝志明[1] 蒲丹[1] 吕晓虹[1] 王强 何岚[1] HU Nan;WANG Pei;ZHANG Jing;WANG Jing;WANG Jing;WU Tianming;WANG Yahong;LI Jiao;LIU Xiaoping;ZHANG Jirong;HAO Zhiming;PU Dan;LYU Xiaohong;WANG Qiang;HE Lan(Department of Rheumatology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;Department of Radiography,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;Clinical laboratory,Shenmu Hospital,Shenmu 719300;Physical Examination Center,Shenmu Hospital,Shenmu 719300;Department of Radiography,Shenmu Hospital,Shenmu 719300;Department of Orthopaedics,Shenmu Hospital,Shenmu 719300,China)

机构地区：[1]西安交通大学第一附属医院风湿免疫科,陕西西安710061 [2]西安交通大学第一附属医院医学影像科,陕西西安710061 [3]神木市医院临床检验科,陕西神木719300 [4]神木市医院体检中心,陕西神木719300 [5]神木市医院影像科,陕西神木719300 [6]神木市医院骨科,陕西神木719300

出　　处：《中国骨质疏松杂志》2023年第6期832-839,共8页Chinese Journal of Osteoporosis

基　　金：国家自然科学基金(82102523);西安交通大学第一附属医院临床研究基金(XJTU1AF-CRF-2020-009)。

摘　　要：目的 探讨骨质疏松(osteoporosis, OP)型膝骨关节炎(knee osteoarthritis, KOA)患者的流行病学、骨转换和生活质量特征。方法 于2017年至2018年间采用问卷调查、SF-36评分、血清骨转换标志物和25(OH)D3水平测定、双膝关节X线和双能X线(DXA)骨密度检测等在神木市3个社区随机抽取40~80岁成年人进行研究,最终共纳入956例受试者,其中662例为女性。根据是否患KOA及骨密度情况,分为4组:OP型KOA组(KOA伴OP或低骨量),单纯KOA组(KOA伴正常骨密度),OP组(仅有OP或低骨量,不合并KOA),健康对照组(无KOA且骨密度正常)。结果 (1)OP型KOA组164人,平均年龄(57.70±7.68)岁,明显高于单纯KOA组(P<0.001)。其总体患病率为17.15%,女性高于男性(72.0%vs 28.0%,P<0.001),绝经后女性最高(72.9%,P<0.001)。以10岁为界的不同年龄组中,该总体患病率随年龄增长而逐渐升高。该组患者血清骨形成和骨吸收标志物水平均显著高于健康对照和单纯KOA组(P<0.001);(2)KOA患者中有72.25%合并OP或低骨量。Kellgren-Lawrence(KL)评分≥2分的OP型KOA的患病率(28.7%)高于单纯KOA组(22.2%);(3)根据SF-36评分,OP型KOA组与OP组(仅有OP或低骨量)和健康对照组相比,在所有评价身体健康的5个维度和心理健康(MH)方面的平均值相对较低。结论 骨量低下是部分KOA患者的临床特征及危险因素,可能加速疾病进展。这些患者的骨转换更活跃。SF-36评分结果表明,OP型KOA患者的身体健康和心理健康均受到严重影响。Objective To explore the epidemiologic,bone turnover and life quality features of osteoporotic KOA.Methods A randomly selected sample of 40-80 years old adults from three communities of Shenmu were recruited in the study between 2017 and 2018.Questionnaire survey was employed and scored by SF-36.Serum bone turnover biomarkers and 25(OH)D 3 were measured.Then,bilateral knee radiography and Dual-energy X-ray absorptiometry(DXA)were recorded as well.956 subjects were enrolled,and 662 were female.All the included participants were classified into four groups according to BMD result and principal diseases.Group KOA-norm represents a condition indicative of knee OA with normal BMD(n=63).Group OP stands for a condition indicative of non-knee OA with OP or osteopenia(n=526).Group osteoporotic KOA is a condition indicative of knee OA with OP or osteopenia(n=164).Group-hc servers as healthy control(n=203).Results(1)Prevalence of osteoporotic KOA was 17.15%(n=164),and it elevated along with aging and became conspicuous in menopausal women(72.9%,P<0.001).The mean age for group osteoporotic KOA was(57.70±7.68)years,obviously higher than group KOA-norm(P<0.001).Their serum levels of both bone formation and bone absorption biomarkers were remarkably higher than those in group hc and group KOA-norm;(2)The prevalence of osteoporotic KOA with Kellgren-Lawrence(KL)scores≥2(28.7%)was higher than that in group KOA-norm(22.2%);(3)According to SF-36 evaluation,relative lower mean values were obtained in group osteoporotic KOA when comparing with group op(non-KOA with OP or osteopenia)and group hc,in terms of all body health dimensions and Mental Health(MH)excluded mental health dimensions.Conclusion Low BMD is a feature for some KOA patients,which is a risk factor of KOA and may accelerate disease progression.Their bone turnover rate turns out to be more active in these patients.The outcome of SF-36 evaluation demonstrates that both body health and mental health of these patients are severely affected by osteoporotic KOA.

关 键 词：骨关节炎 骨质疏松症 OA亚型 骨密度 骨转换标志物 生活质量 

分 类 号：R684.3[医药卫生—骨科学]