HLA-B27阳性与阴性强直性脊柱炎患者骨密度的对比分析

Analysis of BMD in HLA-B27 positive and negative patients with ankylosing spondylitis

目的探讨HLA-B27阳性和阴性AS患者BMD的特点,及两组BMD与其他指标的相关性分析。方法回顾性调查2006年3月至2014年12月中日友好医院中医风湿病科确诊为AS的患者,其中HLA-B27阳性AS患者352例,HLA-B27阴性AS患者99例,双光能X线法检测腰椎、股骨颈、股骨粗隆的BMD,并与年龄、病程、疾病活动性指标、影像学指标、体征进行相关分析。结果 1HLA-B27阳性AS患者各部位BMD较阴性组显著降低;阳性AS患者OP及OT率66.76%,显著高于阴性组OP及OT率41.41%;阳性AS患者腰椎OP发生率、股骨颈、股骨粗隆OT发生率高于阴性组（P〈0.01、0.01、0.05）。2低年龄组（20~29岁）HLA-B27阳性AS患者的腰椎、股骨颈BMD低于阴性组;高年龄组（40~45岁）HLA-B27阳性AS患者的腰椎BMD显著低于阴性组。病程〈5年,HLA-B27阳性AS患者的腰椎BMD低于阴性组;5-10年,阳性AS患者各部位BMD显著低于阴性组（P〈0.05、0.01、0.05、0.01）。3HLA-B27阳性AS患者各部位BMD与年龄、体征具有显著相关性（P〈0.01）。结论 HLA-B27阳性AS患者OP及OT的发生率较阴性患者高,各部位BMD下降程度更明显,尤其是腰椎BMD;HLA-B27阳性AS患者在青年阶段、发病早中期即可出现骨密度的下降,且随着骨密度的下降,功能活动减退。所以对HLAB27阳性患者更要重视及早进行OP及OT的筛查、预防和诊治,尤其要注重腰椎BMD的检查。

Obje ctive The objective of this study,in which the correlation analyses among two BMD datasets and other clinical indicators were conducted in parallel,is to explore the characteristics of BMD in HLA-B27 positive and negative ankylosing spondylitis（ AS） patients. Methods Patients diagnosed with AS in China-Japan Friendship Hospital from March 2006 to December2014,including 652 HLA-B27 positive patients and 99 HLA-B27 negative patients,were retrospectively surveyed. BMD of the lumbar spine,femoral neck,and trochanter were measured by dual energy X-ray absorptiometry. Correlation analyses with age,disease duration,disease activity index,radiological indicators and other clinical signs were performed. Results 1BMD of lumbar spine,femoral neck,and trochanter in HLA-B27 positive AS patients were significantly lower than that in the negative patients（ P〈 0. 01）. The total incidence of OP and OT in HLA-B27 positive AS patients（ 66. 76%） was significantly higher than that of the negative patients（ 41. 41%）. The incidence of OP at lumbar spine and OT at femoral neck and trochanter in HLA-B27 positive AS patients were significantly higher than that of the negative patients（ P 〈 0. 01,0. 01,0. 05）. 2 In the younger age group（ 20-29 years old）,BMD of the lumbar spine and femoral neck were lower in HLA-B27 positive AS patients than in the negative patients.In the older-age group（ 40- 45 years old）,BMD of the lumbar spine were significantly lower in HLA-B27 positive AS patients than in the negative group. In patients who had AS for 5 years or less,BMD of the lumbar spine were lower in HLA-B27 positive AS patients than in the negative patients. In patients who had AS for 5 to 10 years,the total BMD was significantly lower in HLA-B27 positive AS patients than in the negative group（ P 〈 0. 05,0. 01,0. 05,0. 01）. 3 The total BMD in HLA-B27 positive AS patients was closely related with age and clinical signs（ P 〈 0. 01）. Conclusion The incidence of OP and OT was higher in the HLA-B27 positive AS patients,especially at lumbar spine,which showed obvious decrease of BMD. HLA-B27 positive AS patients showed a reduction of BMD at young-age,early onset and middle term,which could lead to function decline of the body. HLA-B27 positive AS patients should pay more attention to the screening,prevention and treatment of OP and OT,especially the examination of lumbar spine BMD.