强直性脊柱炎患者并发骨质疏松及其骨密度和骨代谢生化指标变化情况

The Prevalences of Osteoporosis in Patients with Ankylosing Spondylitis and the Changes of Bone Mineral Density and Bone Metabolic Biochemical Markers among Patients

目的探讨强直性脊柱炎患者并发骨质疏松情况及其骨密度、骨代谢生化指标的变化。方法选取2010年6月—2012年6月河北医科大学第一医院收治的强直性脊柱炎患者120例为研究组,选取同期在我院进行健康体检的健康者80例为对照组。采用双能X线吸收法测定两组腰椎、股骨颈、股骨粗隆、Ward's三角区的骨密度;测定两组骨钙素(BGP)、甲状旁腺激素(PTH)、骨碱性磷酸酶(BALP)、Ⅰ型胶原羧基端前肽(CICP)、Ⅰ型胶原羧基端交联肽(CTX-Ⅰ)、尿脱氧胶原吡啶交联(D-Pyr)水平。采用Bath强直性脊柱炎病情活动指数(BASDAI)评估患者的病情活动度,采用Bath强直性脊柱炎功能指数(BASFI)评估患者的功能情况。结果 120例强直性脊柱炎患者中,21例并发骨质疏松,发生率为17.5%;55例并发骨量减少,发生率为45.8%。研究组的腰椎、股骨颈、股骨粗隆、Ward's三角区的骨密度均较对照组降低(P<0.05)。研究组的BGP、PTH水平较对照组降低,CTX-Ⅰ、D-Pyr水平较对照组升高(P<0.05);BALP、CICP水平与对照组比较,差异均无统计学意义(P>0.05)。研究组的股骨颈、股骨粗隆的骨密度与BASDAI均呈负相关(r值分别为-0.29、-0.25,P<0.05);股骨颈、股骨粗隆、Ward's三角区的骨密度与BASFI均呈负相关(r值分别为-0.29、-0.27、-0.31,P<0.05)。结论强直性脊柱炎患者并发骨质疏松、骨量减少的发生率较高,存在骨密度降低、骨代谢异常情况;骨密度的降低影响了患者的病情进展和功能,应引起临床重视。

Objective To investigate the prevalences of osteoporosis in patients with ankylosing spondylitis （AS） and the changes of bone mineral density and bone metabolic biochemical markers among patients.Methods A total of 120 AS patients who were admitted to the First Hospital Affiliated to Hebei Medical University from June 2010 to June 2012,were selected as the study group,80 healthy physical examiners were included in control group during the same period.The bone mineral density of lumbar spine,femoral neck,trochanter and Ward′s triangle were determined using dual-energy X-ray absorptiometry,and levels of bone metabolic biochemical markers,such as osteocalcin（BGP）,parathyroid hormone（PTH）,bone alkaline phosphatase（BALP）,type Ⅰ collagen carboxy-terminal propeptide（CICP）,type Ⅰ collagen cross-linked carboxy-terminal peptide（CTX-Ⅰ） and urinary deoxy-pyridinoline cross-linked collagen（D-Pyr） were also measured.The disease activity of patients was evaluated by Bath Ankylosing Spondylitis Disease Activity Index（BASDAI）,the functional condition of patients was evaluated by Bath Ankylosing Spondylitis Functional Index（BASFI）.Results Among 120 cases of AS patients,21 also had osteoporosis,the prevalence was 17.5%;55 also had osteopenia,the prevalence was 45.8%.The bone mineral density of lumbar spine,femoral neck,trochanter and Ward′s triangle,levels of BTP and PTH in study group were significantly lower than those in the control group,the levels of CTX-Ⅰ and D-Pyr in study group were significantly higher than those in the control group,the differences were statistically significant（P〈0.05）.There was no significant difference in BALP and CICP levels between study group and control group（P〉0.05）.For study group,the bone mineral density of femoral neck and trochanter were all negatively correlated with BASDAI（r=-0.29 and-0.25,respectively,P〈0.05）;The bone mineral density of femoral neck,trochanter and Ward′s triangle were all negatively correlated with BASFI（r=-0.29,-0.27 and-0.31,respectively,P〈0.05）.Conclusion The prevalences of osteoporosis and osteopenia among AS patients were high,low bone densityand bone metabolism abnormalities commonly existed in AS patients;Low bone mineral density can affect functionality and the progress of the disease,which needs to be paid enough attentions clinically.