类风湿关节炎患者骨质疏松症的危险因素分析

Risk factors of osteoporosis in rheumatoid arthritis

目的探讨类风湿关节炎(RA)患者骨质疏松(OP)的发生情况并分析其危险因素。方法选择RA患者106例(RA组)以及性别、年龄、体重指数等相匹配的健康人63例(对照组),采用双能X线吸收仪测定其正位脊柱L2～4及左侧股骨近端各部位包括股骨颈、Ward’s区、大转子区的骨密度(BMD)。同时详细记录RA患者临床、实验室及影像学资料,酶联免疫法测定其血清25羟基维生素D[25(OH)D]浓度。结果①RA组OP发生率较对照组明显升高(P<0.01),且RA组Ward’s区和大转子区BMD均显著低于对照组(P<0.05);②RA女性组OP发生率较男性组无明显差异,但女性组大转子区BMD较男性组明显降低(P<0.05);③RA绝经组OP发生率较未绝经组明显增高(P<0.05),且RA绝经组各部位BMD均明显低于未绝经组(P<0.01);④RA OP组与非OP组比较,血清25(OH)D水平更低(P<0.01),年龄更大(P<0.01),但Sharp评分无明显差异;⑤Pearson相关分析显示,RA患者的病程分别与其股骨颈以及大转子区BMD呈负相关(r=-0.245,-0.346,P<0.05),红细胞沉降率与L3区BMD呈负相关(r=-0.218,P<0.05),生活质量评分与大转子区BMD呈负相关(r=-0.204,P<0.05);⑥RA激素组OP发生率较非激素组明显增高(P<0.05),且RA激素组患者各部位BMD均明显低于非激素组(P<0.05);⑦Logistic回归分析显示年龄、病程、激素和绝经是OP的危险因素,而25(OH)D是RA患者OP的保护因素。结论 RA患者OP的发生率明显高于匹配的对照组,除年龄、绝经等传统的OP的危险因素外,任何剂量激素、病程长和25(OH)D水平下降都是RA高发OP的危险因素,而生活质量降低和红细胞沉降率等炎性指标也可能参与RA相关性OP的发生。

Objective To investigate the prevalence and risk factors of osteoporosis（OP） in patients with rheumatoid arthritis（RA）.Methods Bone mineral density（BMD） of lumbar spine（L2~4） and left hip（femoral neck,Ward＇s and trochanter major） were measured by dual-energy X-ray absorptiometry（DXA） in 106 patiens with RA and 63 healthy subjects.Clinical data were recorded and the serum 25-hydroxylvitamin D [25（OH）D] levels were detected by enzyme-linked immunosorbent assay（ELISA） in 106 RA patients.Results ① The percentage in RA patients who were diagnosed as having OP was higher than that in the healthy subjects（P0.01）.BMD of Ward＇s and trochanter major areas in RA was significant lower than that in the controls（P0.05）.② The proportion of male with OP was not significantly different to that observed in female,while BMD of trochanter major in female was significantly lower than that in male（P0.05）.③ The rate of RA patients with OP in menopause was higher than that of those who were in premenopause（P0.05）.BMD of all the detected sites in postmenopausal patients was significant lower than that in perimenopausal patients（P0.01）.④ RA patients with OP had lower serum 25（OH）D levels（P0.01） and elder age（P0.01） when compared with those without OP,but there is no significant difference in Sharp score of both hands between the two groups.⑤ The duration of RA was negatively correlated with BMD in femoral neck and trochanter major（r=-0.245,-0.346,P0.05）,ESR was negatively correlated with BMD in the L3（r=-0.218,P0.05）,and negative correlation was also observed between HAQ and BMD of trochanter major（r=-0.204,P0.05）.⑥ The prevalence of OP in RA patients who were treated with corticosteroids previously or currently was higher than that of those never treated with corticosteroids（P0.05）.BMD of all the detected sites in RA patients treated with corticosteroids was lower than that in those without corticosteroid treatment,and the difference was also observed between RA patients and controls（P0.05）.⑦ Analysis of binary logistic regression showed age,course of disease,corticosteroids and menopause were risk factors for RA related osteoporosis,while 25（OH）D was protective factor.Conclusion There is higher incidence of OP in patients with RA.The development of RA related osteoporosis was correlated with age and menopause.Any dose of corticosteroids,long course of disease and 25（OH）D insufficiency/deficiency,in addition,high HAQ scores and markers of inflammation such as ESR may be risk factors,too.