强直性脊柱炎患者发生脊柱骨折危险因素的病例对照研究

Risk Factors for Spinal Fracture in Patients With Ankylosing Spondylitis: A Case- control Study

目的对强直性脊柱炎(AS)患者进行临床资料分析,探究其发生脊柱骨折的危险因素。方法采用病例对照研究方法,选取2009年1月—2013年12月在海南医学院附属医院就诊的AS患者134例,以发生脊柱骨折患者为病例组,共25例;以未发生脊柱骨折患者为对照组,共109例。测量患者指-地距离、Schober指数、BASRI分数;检测血清C反应蛋白(CRP)、红细胞沉降率(ESR);测量全身及各部分骨密度(BMD)T-score值。测定部位主要为:全身BMD T-score,腰椎(LS)BMD T-score,股骨颈(FN)BMD T-score。结果两组患者性别、体质指数(BMI)、病程、BASRI分数、CRP、ESR、全身BMD T-score、LS-BMD T-score、FN-BMD T-score比较,差异均无统计学意义(P>0.05)。两组年龄、跌落创伤史、指-地距离、Schober指数比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,性别、跌落创伤史、病程、Schober指数、ESR、LS-BMD T-score和FN-BMD T-score为影响AS患者发生脊柱骨折的因素(P<0.05)。结论男性、跌落创伤史、ESR高、病程长、Schober指数低、LS-BMD T-score和FN-BMD T-score值低、指-地距离长的AS患者可能更容易发生脊柱骨折,应提前做好预防,及时控制病情,改善体内骨代谢情况,治疗骨量减少和骨质疏松。

Objective To analyze the clinical data of AS patients and investigate the risk factors for their spinal fracture.Methods In this case-control study, we enrolled 134 AS patients who received treatment in the Affiliated Hospital of Hainan Medical College from January 2009 to December 2013.We assigned 25 patients with spinal fracture into the case group and 109 patients without spinal fracture into control group .Finger-earth distance , Schober index and BASRI score were measured;CRP and ESR levels were tested; bone mineral density （ BMD） T-scores of whole body and some segments were measured , mainly including systemic BMD T -score, LS BMD T -score and FN BMD T -score.Results The two groups were not significantly different （P＆gt;0.05） in gender, BMI, disease course, BASRI score, CRP, ESR, systemic BMD T-score, LS BMD T-score and FN BMD T -score.The two groups were significant different （P ＆lt;0.05） in age, history of tumbling trauma, finger-earth distance and Schober index .The multivariate Logistic regression analysis showed that gender , history of tumbling trauma, disease course, Schober index, ESR, LS-BMD T-score and FN-BMD T-score were influencing factors for spinal fracture in AS patients （P＆lt;0.05）.Conclusion Male, history of tumbling trauma, high ESR, long disease course, low Schober index, low LS-BMD T-score, low FN-BMD T-score and high finger-earth distance are associated with more possibility of spinal fracture in AS patients .In these cases , precaution should be made in advance and the disease should be controlled in time, in order to improve bone metabolism and reduce osteopenia and osteoporosis .