双能X线前臂骨密度测定对女性类风湿关节炎患者骨质疏松的诊断价值探讨

Diagnostic value of dual-energy X-ray absorptiometry for examining forearm bone mineral density in female patients with rheumatoid arthritis

目的:探讨双能X线前臂骨密度测定对女性类风湿关节炎患者骨质疏松的诊断价值。方法:选取2014年1月至2017年12月收治的118例女性类风湿关节炎患者为研究对象,检测所纳入患者的非优势侧前臂远端、第2腰椎(L2)至第4腰椎(L4)和左侧髋骨的骨密度。比较中轴骨密度正常与异常患者、前臂骨密度正常与异常患者的各项相关资料;比较不同病程、不同抗体检测结果类风湿关节炎患者的骨密度检测结果;分析前臂骨密度检测结果和L2~L4以及左侧髋骨密度检测结果的相关性。结果:中轴、腰椎以及左髋部骨密度异常患者的年龄、前臂骨密度、T积分值与骨密度正常患者比较,差异有统计学意义(P<0.05);前臂骨密度异常患者的年龄、病程、腰椎骨密度和左髋骨密度与前臂骨密度正常患者比较,差异有统计学意义(P<0.05);病程≤12个月类风湿关节炎患者的前臂骨密度显著高于病程>12个月患者(P<0.05);抗CCP抗体阳性患者的前臂骨密度显著低于抗CCP抗体阴性患者(P<0.05);前臂骨密度测定结果与腰椎、左髋骨骨密度测定结果均呈正相关(r分别为0.531、0.599,P<0.05)。结论:前臂骨密度可作为女性类风湿关节炎患者骨质疏松的筛查指标。

Objective: To investigate the diagnostic value of dual-energy X-ray absorptiometry(DXA) for examining forearm bone mineral density(BMD) in female patients with rheumatoid arthritis(RA). Methods: A total of 118 female patients with RA from Jan2014 to Dec 2017 were selected to examine the BMD of the distal of non-dominant forearm, the second lumbar vertebrae(L2) to the fourth lumbar vertebra(L4) and the left hip. The data of patients between normal and abnormal axis bone density, normal and abnormal bone density in the forearm were compared. The BMD of patients with different course of disease and different antibody test results were compared. The correlation of the forearm BMD with BMD of L2-L4 and the left hip was analyzed. Results: The age,forearm BMD, T integral value of patients with abnormal BMD in the middle axis, lumbar vertebra and left hip were significantly different compared with those of patients with normal BMD(P<0.05). The age, course of disease, lumbar BMD and left hip BMD of patients with abnormal forearm BMD had significant difference compared with those of patients with normal forearm BMD(P<0.05).The forearm BMD in patients with the course of RA≤12 months was significantly higher than that in patients with the course of RA>12 months(P<0.05). The forearm BMD in the anti-CCP antibody-positive patients was significantly lower than that in the anti-CCP antibody negative patients(P<0.05). Forearm BMD were positively correlated with BMD of lumbar vertebrae and left hip(r=0.531,0.599,P<0.05). Conclusion: The forearm BMD can be used as a screening index for osteoporosis in female patients with RA.