类风湿性关节炎患者骨密度变化的临床研究

Study of bone mineral density in patients with rheumatoid arthritis

目的 探讨类风湿性关节炎 (RA)患者骨密度 (BMD)的变化和骨质疏松 (OP)的发生情况及其与临床指标的相关性。方法 采用双能X线骨密度仪 ,测量 5 3例RA患者和 63名正常人的前臂、腰椎和股骨区的BMD ,并同时测定各临床指标。结果 RA患者的骨量丢失较对照组明显(P <0 .0 5 ) ,除股骨颈外 ,各测定部位的BMD均明显低于对照组 (P <0 .0 5～ 0 .0 1)。RA患者中发生OP组较非OP组年龄更大 (P <0 .0 0 1) ,关节功能更差 (P <0 .0 0 1) ,健康评估表积分更高 (P <0 .0 1) ,握力更低 (P <0 .0 5 )。 2 8例服用糖皮质激素的RA患者中有 13例 ( 4 6.4% )发生OP ,明显高于未服用糖皮质激素组的 5 /2 5 ( 2 0 .0 % ) ( χ2 =4.113 ,P =0 .0 5 ) ,服用激素组腰椎 3 (L3 )的BMD明显低于未服用激素组 (t =2 .163 ,P =0 .0 5 )。LogisticRegression分析显示年龄 (OR =1.10 3 ,P =0 .0 1)和关节功能 (OR =5 .689,P =0 .0 1)为RA患者OP发生的相关因素。结论 RA患者多部位的BMD均显著降低。其BMD的降低和OP的发生是多因素的 ,与年龄。

Objective To investigate the change of bone mineral density(BMD) and development of osteoporosis(OP) in the patients with rheumatoid arthritis(RA).Methods BMD of forearm, lumbar vertebrae(L 2～4and hip in 53 patients with RA and 63 healthy subjects as control were measured by dual energy X-ray absorptiometry.Results The bone loss in patients with RA was more obvious than that in healthy subjects (P<0.05).BMD in all site detected were significantly lower than that in detected except that in hip neck (P<0.05～0.01).Patients determined as OP had elder age (P<0.001),more severer joint function (P<0.001),higher Health Assessment Questionnaire scores (P<0.01) and worse grip strength (P<0.05) than those without OP.46.4% (13/28) of patients treated with corticosteroids were determined as OP,which was higher than that (20.0%,5/25) of those treated without corticosteroids (χ 2 =4.113,P= 0.05).Logistic regression analysis showed age (OR=1.103,1.035-1.175, P=0.003) and joint functional status (OR=5.689,1.638-19.766,P=0.05) were correlated with OP in patient with RA.Conclusion There is more obvious bone loss in patients with RA than that in controls.The BMD reduction and occurrence of OP are correlated with age,the severity of arthritis and whether patients are treated with corticosteroids or not.