类风湿关节炎患者骨质疏松及其相关因素的初步调查

Primary study of osteoporosis and related factors in patients with rheumatoid arthritis

目的探讨类风湿关节炎(RA)患者中骨质疏松(OP)的发生情况及其相关危险因素。方法采用GE Insight/Achilles express高频率声波(超声波)检测右跟骨的骨质状态,测量90例RA患者和80名年龄、性别基本匹配的健康志愿者的跟骨骨密度(BMD),按WHO确定的诊断标准将RA患者和正常受试者各分为3组,即骨量正常、骨量减少和骨质疏松组。采用问卷形式调查患者的性别、年龄、体重、身高、吸烟史、钙剂摄入、骨折家族史、RA病程及糖皮质激素应用等因素,分析其与OP的相关风险。结果 RA患者骨量正常、骨量减少和骨质疏松组的构成比与对照组相比较差异有统计学意义(P<0.05)。提示RA患者中发生OP的概率较对照组发生更大。在年龄、性别无明显差异的情况下,RA病程、吸烟、激素、骨折家族史是增加OP的危险因素。多因素Logistic分析得到的回归模型:RA伴发骨质疏松=-0.530+0.164×病程+3.304×吸烟+1.783×骨折家族史。结论 RA患者较健康志愿者更易发生骨量减少和骨质疏松。RA患者BMD的降低和OP的发生是多因素的,其中RA病程是RA患者发生OP的独立危险因素,早期诊断与治疗对预防RA患者发生OP具有重要意义。

Objective To investigate the change of bone mineral density （BMD） and related factors in the patients with rheumatoid arthritis （RA）. Methods BMD of right calcaneal in 90 patients with RA and 80 healthy subjects as control were measured by GE Insight/Achilles express （ ultrasonic waves with bone osteoporosis）. According to WHO defined criteria, we divided RA patients and control into three groups： normal, osteopenia and osteoporosis. The patient＇s gender, age, weight, height, smoking, calcium intake, family history of brittle bone, duration, corticosteroid and other factors, analyzing their risks associated with the osteoporosis （OP）. Results Constituent ratio of bone mass in three groups of RA were different from the control group （ P 〈 0.05 ）. Suggesting that more probability of OP in RA patients than in the control group. Age and gender were no significant differences between in two groups. Duration of RA, smok- ing, corticosteroid and family history of brittle bone were the risk factors to the OP. The regression model ： RA associated with osteoporosis = -0. 530 ＋ 0. 164 × duration ＋ 3. 304 x smoking ＋ 1. 783 × family history of brittle bone. Conclusion Compared to healthy control, there was more obvious bone loss or OP in patients with RA. BMD reduction and occurrence of OP in RA patients were correlated with many factors, especially, the duration of RA. Early diagnosis and treatment of RA for the prevention of occurrence of OP was very important.