女性类风湿关节炎患者骨密度变化的影响因素

Factors associated with the change of bone mineral density in female patients with rheumatoid arthritis

目的:探讨女性类风湿关节炎(RA)患者骨质疏松(OP)的危险因素及其与临床指标的相关性。方法:使用双能X线骨密度仪测定115例女性RA患者和101名健康女性L1～L4、股骨颈、全髋等部位骨密度(BMD),并观察患者的疾病活动指标和实验室指标。结果:女性RA患者患OP发生率高于健康女性(P<0.01),其各部位BMD均低于对照组(P<0.05～P<0.01)。OP组RA患者各部位BMD均明显低于非OP组(P<0.01)。OP组患者年龄更大、绝经年数更长、病程和晨僵时间更长、疼痛关节数更多、HAQ平均积分更高、关节功能和X线分期更差(P<0.05～P<0.01)。RA组OP性骨折的概率明显高于健康女性(P<0.01),使用糖皮质激素的RA患者第L1～L4的BMD低于未使用患者(P<0.05)。Logistic Regression分析显示绝经[OR=4.582(1.503～13.974),P<0.01]和X线分期[OR=2.267(1.233～4.167),P<0.01]为RA患者OP发生的主要危险因素。结论:女性RA患者发生OP和骨折风险均显著高于健康女性,其OP的发生和多因素相关,绝经年数更长、X线分期较差、使用糖皮质激素是RA患者发生OP的主要危险因素。

Objective：To study the risk factors of osteoporosis（OP） in female patients with rheumatoid arthritis（RA）,and the related clinical factors. Methods：The bone mineral density（BMD） of the lumbar vertebrae（L1-L4）,femoral neck and total femoral of 115 female patients with RA and 101 female healthy subjects area were measured by dual energy X-ray absorptiometry;and the clinical and laboratory indexes were observed in the meantime. Results：The incidence of OP in female patients with RA was significant higher than that in healthy subjects（P0.01）.The BMD of all positions in female patients with RA was lower than that in healthy subjects（P0.05-P0.01）.The RA patients diagnosed as having OP had lower BMD than those having not（P0.01）.The former had elder ages,longer years of menopause,longer duration of disease and morning stiffness,tender joint counts,higher HAQ scores and worse function of joint and X-ray status than the latter（P0.05-P0.01）.The osteoporotic fracture probability in patients with RA was obviously higher than that in healthy subjects in the next 10 years（P0.01）.The BMD of L1-L4 in female patients with RA who were taking corticosteroid was lower than that of patients taking no corticosteroid（P0.05）.Logistic regression analysis showed that menopause[OR=4.582（1.503-13.974）,P0.01] and X-ray status[OR=2.267（1.233-4.167）,P0.01） were the main risk factors for the OP in female patients with RA. Conclusions：Compared with the healthy subjects,the incidence of OP and the risk of osteoporotic fracture in female patients with RA rise apparently.The occurrence of OP is related with several risk factors,such as menopause,worse X-ray status and taking corticosteroid.