类风湿关节炎患者股骨和腰椎部位骨密度的临床研究

Clinical study of bone mineral density at site of proximal femur and lumbar vertebrae in patients with rheumatoid arthritis

目的探讨类风湿关节炎(RA)患者股骨和腰椎部位骨密度(BMD)的变化和骨质疏松(OP)的发生情况。方法采用DEXA法测定120例RA患者和120例正常人的股骨和腰椎部位BMD,详细记录RA患者各临床及实验室指标。结果 (1)RA患者总股骨区、腰椎2、腰椎3、腰椎4和腰椎2～4部位BMD均明显低于正常人(P<0.05),而股骨颈、Ward和大转子区BMD在两组间无差别(P>0.05)。RA患者总的OP发生率为34.2%,明显高于正常人15.0%(χ2=11.889,P=0.001)。(2)总股骨区:与无OP的RA患者比较,有OP患者的病程更长(t=3.658,P<0.0001)、健康状况问卷(HAQ)积分更高(t=2.076,P=0.040)、关节功能更差(χ2=14.392,P=0.002)、双手关节X线分期更差(χ2=7.888,P=0.048)。腰椎2～4区:与无OP的RA患者比较,有OP患者的年龄更大(t=2.476,P=0.015)。(3)服用糖皮质激素的RA患者腰椎2和4的OP发生率(29.2%、19.4%)明显高于未使用糖皮质激素患者(12.5%、4.2%)(P=0.032、0.016)。(4)Logistic Regression分析显示:病程(OR=1.192,P=0.023,95%CI:1.024～1.386)和关节功能(OR=5.453,P=0.033,95%CI:1.142～26.035)为RA患者总股骨区发生OP的危险因素;年龄(OR=1.058,P=0.016,95%CI:1.010～1.058)为RA患者腰椎2～4区发生OP的危险因素。结论 RA患者OP的发生率明显升高,股骨和腰椎的BMD均普遍降低,但股骨和腰椎部位OP的发生机制是有不同之处的。

Objective To investigate the change of bone mineral density(BMD)at the site of proximal femur and lumbar vertebrae and the occurrence of osteoporosis(OP)in patients with rheumatoid arthritis(RA).Methods BMD of proximal femur and lumbar vertebrae(L2-4)in 120 patients with RA and 120 healthy control subjects were measured by dual energy X-ray absorptiometry.The clinical and lab data were also recorded in details simultaneously.Results (1)BMD at total femoral area and lumbar 2,lumbar 3,lumbar 4,lumbar 2-4 region in patients with RA were obviously lower than that in healthy subjects(P<0.05).BMD at femoral neck,Ward region and greater trochanter area in RA were similar to that in normal group(P>0.05).The incidence of total OP in RA was 34.2%,which significant higher than those in the control group(15.0%)(P=0.001).(2)Patients determined as OP according to BMD at proximal femur had longer duration of disease(t=3.658,P<0.0001),higher HAQ scores(t=2.076,P=0.040),worse function of joint(χ2=14.392,P=0.002),more severer stage of X-ray scan of hands(χ2=7.888,P=0.048).Patients determined as OP according to BMD at Lumbar 2-4 had elder age(t=2.476,P=0.015).(3)The incidences of OP at position of lumbar 2(29.2%)and lumbar 4(19.4%)in RA who taking corticosteroid were obviously higher than that who treated without corticosteroid(12.5%,4.2%)(P=0.032,0.016).(4)Logistic Regression analysis indicate:duration of disease(OR=1.192,P=0.023,95% CI:1.024-1.386)and joint function(OR=5.453,P=0.033,95% CI:1.142-26.035)were risk factors for the occurrence of OP in RA at site of proximal femur.Age(OR=1.058,P=0.016,95% CI:1.010-1.058)was the only risk factor for the occurrence of OP in RA at site of lumbar 2-4.Conclusions Compared with healthy control subjects,the incidence of OP in patients with RA rise apparently.Pathogenesis of OP in RA patients at the site of proximal femur or lumbar are different.