10年前后RA患者骨质疏松发生情况的横断面对比研究

Comparison of osteoporosis status in patients with rheumatoid arthritis in 10 years:a cross-sectional study

目的横断面对比10年前后类风湿关节炎(RA)患者骨密度(BMD)的变化和骨质疏松(OP)的发生情况,分析其发生的原因。方法采用DEXA法测定2011年确诊的120例RA患者和120例正常人股骨和腰椎部位BMD,详细记录RA患者各临床及实验室资料。同时与2001年53例RA患者的BMD等资料进行横断面对比。结果①正常人、2001年RA及2011年RA患者3组间OP发生率有明显差别(15.0%、22.6%、34.2%;x2=17.218,P=0.002)。②2001年53例RA患者中,非OP患者的年龄(43.73±15.06 vs 59.25±14.75,t=3.154,P=0.003)、CRP(35.35±31.91 vs 58.74±31.81,t=2.235,P=0.030)明显低于OP组。③2011年120例RA患者中,非OP患者的年龄(48.94±11.98 vs 56.66±14.26,t=3.135,P=0.002)、HAQ(1.39±0.67 vs 1.66±0.73,t=2.067,P=0.041)明显低于OP组。④2001年发生OP与非OP的RA患者中,服用糖皮质激素的患者比例无差别(P>0.05)。2011年发生OP的RA患者中服用糖皮质激素的患者比例为73.2%(30/41),明显高于非OP患者中的53.2%(42/79)(x2=4.501,P=0.034)。⑤与2001年RA相比,2011年RA患者的DAS28更低(6.77±1.38 vs 5.97±1.30,t=3.613,P<0.0001)、关节功能更好(1:18:22:12 vs 9:57:50:3,x2=20.690,P<0.0001),但关节X线分期更差(7:26:12:8 vs 13:27:53:23,x2=13.302,P=0.004)。⑥Logistic Regression分析发现:年龄(OR=1.093,P=0.010,95%CI:1.022～1.169)和CRP(OR=1.025,P=0.037,95%CI:1.002～1.48)为2001年RA患者发生OP的危险因素;年龄(OR=1.047,P=0.012,95%CI:1.010～1.085)和HAQ评分(OR=2.040,P=0.046,95%CI:1.013～4.111)为2011年RA患者发生OP的危险因素。结论 10年前后的横断面对比研究提示,RA患者OP发生率明显高于正常人,且呈上升趋势;高龄和RA疾病活动性是两个不同年度的横断面资料中RA患者发生OP的相同的危险因素。RA患者中糖皮质激素的使用比例的增高,可能是其关节炎症表现好转,但关节X线分期更差及OP发生率更高的原因之一。

Objective To compare cross-sectionally the change of bone mineral density（BMD） and the incidence of osteoporosis（OP） in 10 years in patient with rheumatoid arthritis（RA）,and to analyze the possible cause of the change.Methods BMD of the proximal femur and the lumbar vertebrae（L2-4） in 120 patients with RA,diagnosed in 2011,and in 120 healthy control subjects were measured using dual energy X-ray absorptiometry.The clinical and laboratory data were also recorded in details simultaneously and compares with those of 53 RA patients collected 10 years ago.Results（1） The incidence of OP among normal group（15.0%）,RA patients of 2001（22.6%）,and RA patients of 2011（34.2%） differed significantly（x2=17.218,P=0.002）.（2） Among 53 RA patients of year 2001,the age（43.73±15.06 vs 59.25±14.75,t=3.154,P=0.003） and CRP（35.35±31.91 vs 58.74±31.81,t=2.235,P=0.030） were significantly lower in patients without OP than those with OP.（3） Among 120 RA patients of year 2011,the age（48.94±11.98 vs 56.66±14.26,t=3.135,P=0.002） and HAQ score（1.39±0.67 vs 1.66±0.73,t=2.067,P=0.041） were significantly lower in patients without OP than those with OP.（4） The percentage of RA patients taking corticosteroid in patients with OP is similar to that in patients without OP（P0.05） in 2001.However,OP incidence was significantly higher in patients taking corticosteroid（73.2%） than in patients without taking corticosteroid（53.2%） in RA patients in 2011（x2=4.501,P=0.034）.（5） Comparing to those in 2001,RA patients in 2011 had lower DAS28（6.77±1.38 vs 5.97±1.30,t=3.613,P0.0001） and better joint function（1：18：22：12 vs 9：57：50：3,x2=20.690,P0.0001）,but worse X-ray stage（7∶26∶12∶8 vs 13∶27∶53∶23,x2=13.302,P=0.004）.（6） Logistic regression analysis showed that age（OR=1.093,P=0.010,95% CI 1.022～1.169） and CRP（OR=1.025,P=0.037,95% CI 1.002～1.48） were risk factors for OP in RA patients in 2001,and age（OR=1.047,P=0.012,95% CI 1.010～1.085） and HAQ score（OR=2.040,P=0.046,95% CI 1.013～4.111） were risk factors for OP in RA patients in 2011.Conclusion The 10-year cross-sectional study shows that the incidence of OP is significantly higher in patients with RA than in healthy subjects,and the increase trend continues.High age and RA activity are risk factors for osteoporosis in both cross-sectional year data.The higher proportion of corticosteroid use in RA patients may lead to a better RA outcome,but worse X-ray status and higher incidence of OP.