绝经后女性类风湿关节炎中脂蛋白水平在骨质疏松症中的新兴作用  

The emerging role of blood lipoprotein levels in osteoporosis of postmenopausal women with rheumatoid arthritis

作　　者：蒋总 姚晓玲 唐芳 马武开 Jiang Zong;Yao Xiaoling;Tang Fang;Ma Wukai(Second Clinical School of Guizhou University of Traditional Chinese Medicine,Guiyang 550002,China;Department of Rheumatology and Immunology,the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang 550001,China)

机构地区：[1]贵州中医药大学第二临床医学院,贵阳550002 [2]贵州中医药大学第二附属医院风湿免疫科,贵阳550001

出　　处：《中华风湿病学杂志》2023年第7期446-451,共6页Chinese Journal of Rheumatology

基　　金：国家自然科学基金项目(82160917);贵州省中医风湿免疫疾病临床研究中心(黔科合平台人才[2020]2202号);贵州省教育厅青年科技人才成长项目(黔教合KY字[2022]262号)。

摘　　要：目的通过回顾性分析绝经后RA患者脂蛋白表达水平与骨质疏松症(OP)发生风险的相关性及其影响因素。方法回顾性收集2017年7月至2020年5月住院明确诊断RA的患者,通过骨密度进行分组分析,使用相关性分析、二分类Logistic回归来量化实验室指标和结果之间的独立关联,限制性立方样条(RCS)拟合OP风险发生的关系。结果根据纳入及排除标准纳入666例符合条件的RA患者,其中RA-OP 253例,RA-non-OP 413例,通过对比人口学特征排除相关影响因素后发现,发现HDL-C(r=-0.11,P=0.006)、LDL-C(r=0.12,P=0.003)与RA-OP有明显的相关性(P<0.05),二分类Logistic回归显示随着BMI[OR值(95%CI)=0.81(0.77,0.86),P<0.001]、钙[OR值(95%CI)=0.24(0.10,0.63),P<0.001]、HDL-C[OR值(95%CI)=0.38(0.22,0.66),P<0.001]的增加,RA患者发生OP风险降低,与之相反,随着年龄[OR值(95%CI)=1.10(1.07,1.21),P<0.001]、病程[OR值(95%CI)=1.00(1.00,1.00),P=0.020]、LDL-C[OR值(95%CI)=1.71(1.38,2.12),P<0.001]的增加,罹患OP的风险也增加。结论HDL-C、LDL-C与RA-OP的发生有明显的相关性,这2个指标可作为OP发生的预测因子和RA患者疾病监测的良好指标。Objective To retrospectively analyze the correlation between blood lipoprotein levels and the risk of osteoporosis(OP)development in postmenopausal patients with RA and its influencing factors.Methods Patients hospitalized with a definite diagnosis of RA from July 2017 to May 2020 were retrospectively collected and analyzed by bone mineral density(BMD)in subgroups,using correlation analysis,di-chotomous Logistic regression to quantify independent associations between laboratory test results and out-comes,and restrictive cubic spline(RCS)to fit the relationship of OP risk occurrence.Results Six hundred and sixty-six eligible RA patients were included according to inclusion criteria,including 253 RA-OP and 413 RA-non-OP patients.After exclusion of relevant influencing factors by comparing demographic characteristics,a significant correlation was found between blood HDL-C(r=-0.11,P=0.006)LDL-C(r=0.12,P=0.003)levels and RA-OP(P<0.05),and dichotomous Logistic regression showed that as BMI(OR(95%CI)=0.81(0.77,0.86),P<0.001],calcium[OR(95%CI)=0.24(0.10,0.63),P<0.001],HDL-C[OR(95%CI)=0.38(0.22,0.66),P<0.001]increased,the risk of developing OP in RA patients decreased.In contrast,the risk of developing OP increased with increasing age[OR(95%CI)=1.10(1.07,1.21),P<0.001),disease duration[OR(95%CI)=1.00(1.00,1.00),P=0.020],and LDL-C[OR(95%CI)=1.71(1.38,2.12),P<0.001].Conclusion Blood HDL-C and LDL-C levels are significantly correlated with the development of RA-OP,and can be used as predictors of OP development and good indicators for disease monitoring in RA patients.

关 键 词：关节炎 类风湿 骨质疏松 血脂异常 绝经后期 

分 类 号：R580[医药卫生—内分泌]