类风湿关节炎患者骨质疏松与骨侵蚀关系的研究

Association of bone mineral density and bone erosion of rheumatoid arthritis

目的探讨类风湿关节炎（RA）患者骨质疏松的发生情况及其与关节骨侵蚀及其他临床指标的相关性。方法采用双能X线骨密度仪，测量111例RA患者和30名健康人腰椎和股骨区的骨密度（BMD），并同时测定手关节X线分期及其他各临床指标。结果RA患者的骨量丢失较对照组咀显，骨质疏松的患病率更高（P〈0．05），随关节骨侵蚀加重，各测定部位的BMD呈下降趋势，手关节病变Ⅲ期、Ⅳ组的BMD均明显低于对照组（P〈0．05）。RA患者中骨质疏松组较非骨质疏松组病程更长（P〈0．05），手关节骨侵蚀更重（P〈0．05），关节功能更差（P〈0．05），服用糖皮质激素比例更高（P〈0．05）。Logistic回归分析显示手关节骨侵蚀（OR=0．636，0．424～0．954，P=0．029）和糖皮质激素服用情况（OR=2．696，1．026～7．083，P=0．044）是与RA患者骨质疏松发生有显著相关的因素。结论随手关节骨侵蚀加重RA患者BMD呈下降趋势，RA患者骨质疏松的发生是多因素的，主要与关节骨侵蚀和是否服用糖皮质激素等有关。

Objective To investigate the occurrence of osteoporosis and the association between osteoporosis and bone erosion of rheumatoid arthritis （RA）. Methods Bone mineral density （BMD） of vertebrae L1-4 of lumbar region ,femur neck and greater trochanter of the left side by dual energy X-ray absorptiometry was measuredin 111 patients with RA and 30 healthy subjects （as control）. Their radiographic changes in joints and other risk factors for osteoporosis were recorded. Results The RA patients had sign- ificantly（P〈0.05） higher frequency of osteoporosis and there was a significant decrease of BMD at all measured sites with severer bone erosion （radiographic changes Ⅲ and Ⅳ in joints） compared with matched healthy controls （P〈0.05）. RA Patients who were defined to be OP had longer disease duration, severer joint damage, severer bone erosion and higher dosage of corticosteroids usage than RA Patients without OP （P〈0.05）. Logistic regression analysis showed bone erosion （0R=0.636, 0.424-0.954, P=0.029） and the use of cortieosteroids （OR=2.696, 1.026-7.083, P=0.044） were correlated with OP in patient with RA. Conclusion There is more evident bone loss in patients with RA than controls. Patients with severe bone erosion have lower BMD at all sites of measurement.The BMD reduction and occurrence of OP are correlated with the severity of arthritis and treatment with corticosteroids or not.