50例绝经后高疾病活动期的女性类风湿关节炎骨密度的临床观察

Clinical observation of bone mineral density in fifty postmenopausal women with high disease activity of rheumatoid arthritis

目的观察绝经后高疾病活动期的女性类风湿关节炎患者骨矿物质密度水平的变化。方法收集50例绝经后女性RA患者一般临床资料,包括年龄、RA病程、绝经年龄、ESR、CRP、RF、抗CCP抗体、DSA28评分及雌二醇水平,应用双能X线吸收法(DXA)测定50例患者腰椎L_(1-4)和左髋关节部位的骨密度,分析其骨密度(BMD)的情况。结果 1.50例绝经后女性RA的DSA28评分大于5.1,属高疾病活动期,骨质疏松组发生率52%;远高于骨量减少组(30%)及骨密度正常组(18%)。2.骨质疏松组的绝经年龄比非骨质疏松组明显提前(P=0.005),抗CCP抗体水平明显升高(P=0.037),有统计学意义,但在年龄、病程、RF、DSA28评分及雌激素方面两者无统计学差异。3.Logistic回归分析结果显示抗CCP抗体(OR值1.025,P=0.041)是绝经后高疾病活动女性RA骨质疏松的独立危险因素。4.骨质疏松组,腰椎总骨密度较髋关节显著降低(P<0.001);腰椎组内比较以腰1椎体BMD最低,而后依次为腰2,腰3、腰4(P=0.0003),左髋关节组内比较以大转子BMD最低,而后依次为股骨颈、小转子(P<0.0001)。结论绝经后高疾病活动期的女性RA患者存在明显的骨质疏松,以腰椎骨密度(特别L_1)下降最明显;抗CCP抗体可能是高疾病活动期的女性类RA患者发生骨质疏松的危险因素。

Objective To investigate the changes of bone mineral density（BMD） in postmenopausal patients with high disease activity rheumatoid arthritis（RA）.Methods The general clinical data of 50 postmenopausal patients with RA was collected,including age,course of disease,menopausal age,erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）,rheumatoid factors（RF）,anti-cyclic citrullinated peptide antibody（anti-CCP）,disease activity score in 28 joints（DSA28）,and estrogen levels.BMD of the lumbar spine L1-4 and left hip was measured with dual energy X-ray absorptiometry（DXA） and was analyzed.Results 1） 50 postmenopausal patients with RA（DSA28 score 〉5.1） belong to high disease activity.The incidence of osteoporosis,osteopenia,and normal bone mass in postmenopausal patients was 52%,30%,and 18%,respectively.2） Compared with those in non-osteoporosis group,the age of menopause was significantly advanced in osteoporosis group（P = 0.005）,and the level of anti-CCP increased significantly（P = 0.037）.There were no statistical differences of age,duration,RF,DSA28 score,and estrogen levels between the two groups.3） Logistic regression analysis showed that anti-CCP（OR 1.025,P = 0.041） was independent risk factor for osteoporosis in postmenopausal patients with high disease activity RA.4） In osteoporosis group,the total BMD of the lumbar spine was significantly lower than that of the hip（P 〈0.001）.Among the lumbar spines,BMD of L1 was the lowest,followed by L2,L3,and L4（P = 0.0003）.In the left hip,BMD of the greater trochanter was the lowest,followed by the femoral neck and the lesser trochanter（P〈 0.0001）.Conclusion Osteoporosis in postmenopausal patients with high disease activity RA is common.BMD of the lumbar spine（especially L1） decreased most significantly.Anti-CCP may be a risk factor for osteoporosis in postmenopausal patients with high disease activity RA.