男性强直性脊柱炎患者中医证型与骨密度关系及低骨密度危险因素分析

Relationship Between TCM Syndromes and Bone Mineral Density in Male Patients with Ankylosing Spondylitis and Analysis on Risk Factors of Low Bone Mineral Density

目的分析男性强直性脊柱炎(AS)中医证型与骨密度的关系及低骨密度发生的危险因素。方法收集2013年9月-2018年9月中日友好医院中医风湿科男性AS患者192例,其中肾虚督寒证106例、肾虚湿热证86例,分析不同证型、不同骨密度患者的临床资料,采用Logistic回归模型分析患者低骨密度危险因素及不同中医证型患者低骨密度危险因素。结果肾虚湿热证患者全髋骨密度显著低于肾虚督寒证患者,肾虚湿热证患者病程、红细胞沉降率(ESR)、C-反应蛋白(CRP)、AS疾病活动评分(ASDAS-CRP)、Bath AS测量指数(BASMI)、改良Stoke AS脊柱评分(mSASSS)显著高于肾虚督寒证患者(P<0.05)。Logistic回归分析显示,肾虚湿热证型、病程、ESR、ASDAS-CRP、mSASSS、Bath AS功能指数(BASFI)、BASMI与全髋低骨密度的发生显著相关,肾虚督寒证患者疾病活动指标ESR、ASDAS-CRP是全髋低骨密度的危险因素,肾虚湿热证患者病程、ASDAS-CRP、mSASSS、BASFI是全髋低骨密度的危险因素(P<0.05)。结论肾虚湿热证患者全髋骨密度低于肾虚督寒证患者,肾虚湿热证型、病程、ESR、ASDAS-CRP、mSASSS、BASFI、BASMI是男性AS患者低骨密度发生危险因素。

Objective To analyze the relationship between TCM syndromes and bone mineral density in male patients with ankylosing spondylitis(AS)and the risk factors of low bone mineral density.Methods Totally 192 male AS patients in Department of TCM Rheumatology in China-Japan Friendship Hospital from September 2013 to September 2018 were collected,among which there were 106 cases with kidney deficiency and cold syndrome and 86 cases with kidney deficiency and dampness heat syndrome.Clinical data of patients with different syndrome types and bone mineral density were analyzed.The risk factors of low bone mineral density and the factors in different TCM syndrome types in male AS patients were analyzed by Logistic regression model.Results The total hip bone mineral density of the patients with kidney deficiency and dampness heat syndrome was significantly lower than that of the patients with kidney deficiency and cold syndrome.The duration of disease,ESR,CRP,ASDAS-CRP,Bath ankylosing spondylitis metrology index(BASMI)and modified Stoke ankylosing spondylitis spine score(mSASSS)of the patients with kidney deficiency and dampness heat syndrome were significantly higher than those of the patients with kidney deficiency and cold syndrome(P<0.05).According to the Logistic regression analysis of the related factors of low bone mineral density in male AS patients,it was found as for that kidney deficiency and dampness heat syndrome,duration of disease,ESR,ASDAS-CRP,mSASSS,Bath ankylosing spondylitis function index(BASFI)and BASMI were significantly related to the occurrence of low bone mineral density in the total hip;ESR and ASDAS-CRP were risk factors of low bone mineral density in the total hip in the patients with kidney deficiency and cold syndrome;the duration of disease,ASDAS-CRP,mSASSS and BASFI were risk factors of low bone mineral density in the total hip in the patients with kidney deficiency and dampness heat syndrome(P<0.05).Conclusion Patients with kidney deficiency and dampness heat syndrome have lower total hip bone mineral density than those with kidney deficiency and cold syndrome.Kidney deficiency and dampness heat syndrome,duration of disease,ASDAS-CRP,mSASSS,BASFI and BASMI are the risk factors of low bone mass in male AS patients.