类风湿关节炎患者跟骨超声骨密度与骨质疏松的临床研究

Clinical Study of Ultrasonic Calcaneal Bone Mineral Density and Osteoporosis in Patients With Rheumatoid Arthritis

目的 探究类风湿关节炎(rheumatoid arthritis,RA)患者的跟骨超声骨密度变化与骨质疏松(osteoporosis,OP)的发生情况。方法 本研究自2019年1月—2021年1月共纳入RA患者260例。详细记录RA患者临床资料,包括性别、年龄、病程、体质量指数(body mass index,BMI)、抗环瓜氨酸肽抗体(anti-cyclic citrullinated peptide antibody,抗CCP抗体)及跟骨骨密度(阿洛卡跟骨超声骨密度仪)与骨密度系列参数[如声速(speed of sound,SOS)、骨折风险系数(osteosono-assessment index,OSI)、骨强度(transmission index,TI)],其中SOS以中国同年龄、同性别的健康人群的参考值为基准计算T值。分析RA患者的骨密度情况以及可能影响骨密度的因素。有60例RA患者纳入治疗组,给予碳酸钙600 mg/d和骨化三醇0.25μg/d治疗12个月,比较治疗前、治疗12月后骨密度系列参数的差异。结果 (1)260例RA患者平均年龄为(53.28±12.65)岁,BMI为(25.23±2.61)kg/m2,病程为60(24,120)个月。(2)所有患者中,100例(38.46%)骨密度正常,160例(61.54%)骨密度异常,其中116例(44.62%)骨密度减少,44例(16.92%)骨质疏松。(3)RA患者中,女性骨密度(-1.39±0.21)低于男性患者(-1.04±0.50)。(4)早期RA患者的年龄(47.55±12.32)岁低于长病程RA患者(54.92±12.31)岁,而且骨密度高于长病程RA患者(-0.85±0.14vs.-1.46±0.08),差异有统计学意义(t=42.424,P <0.01)。(5)与治疗前比较,钙剂+骨化三醇治疗12个月后骨密度、TI明显高于治疗前,差异有统计学意义(P <0.05),而骨强度在治疗前后无明显变化。(6)相关分析显示,年龄、病程以及抗CCP抗体阳性与RA患者跟骨骨密度之间存在负相关。结论 RA患者跟骨骨密度可以作为筛查骨质疏松的辅助工具,OP在RA患者中的发生率较高,RA患者骨密度随年龄、病程增长而下降,抗CCP抗体阳性可能是RA患者发生OP的危险因素。补充钙剂及活性维生素D有助于防治骨质疏松。

Objective To investigate the changes of calcaneal ultrasound bone mineral density and the occurrence of osteoporosis(OP) in patients with rheumatoid arthritis(RA). Methods A total of 260 RA patients were enrolled in this study from January 2019 to January 2021. The clinical data of RA patients were recorded in detail,including gender, age, disease course, body mass index(BMI), anticyclic citrullinated peptide antibody(anti-CCP antibody) and calcaneal bone mineral density(Aloca calcaneal ultrasound absorptiometry)and bone mineral density series parameters [such as speed of sound(SOS), fracture risk factor(osteosono-assessment index, OSI), bone strength(transmission index, TI)], among them, SOS calculated T value based on the reference value of healthy people of the same age and sex in China. To analyze the bone mineral density of patients with RA and the factors that may affect bone mineral density. Sixty RA patients were included in the treatment group, and were treated with calcium carbonate 600 mg/d and calcitriol 0.25 μg/d for 12 months,and the differences in bone mineral density parameters before and after 12 months of treatment were compared. Results(1) The average age of 260 RA patients was(53.28±12.65) years old, the BMI was(25.23±2.61) kg/m2, and the disease course was 60(24, 120) months.(2)Among all patients, 100(38.46%) had normal BMD, 160(61.54%) had abnormal BMD, 116(44.62%) had decreased BMD, and 44(16.92%)had osteoporosis.(3) Among RA patients, female bone mineral density(-1.39±0.21) was lower than that of male patients(-1.04±0.50).(4)The age of patients with early RA(47.55±12.32) years was lower than that of patients with long-course RA(54.92±12.31) years, and the bone mineral density was higher than that of patients with long-course RA(-0.85±1.07) vs.(-1.45±1.18), the difference was statistically significant(t=42.424, P < 0.01).(5) Compared with before treatment,the bone mineral density and TI after 12 months of calcium + calcitriol treatment were significantly higher than before treatment, and the difference was statistically significant(P < 0.05), while bone strength had no significant change before and after treatment.(6) Correlation analysis showed that there was a negative correlation between age,disease course and positive anti-CCP antibody and calcaneal bone mineral density in RA patients. Conclusion The calcaneal bone mineral density of RA patients can be used as an auxiliary tool for the screening of osteoporosis. The incidence of OP is high in RA patients.The bone mineral density of RA patients decreases with age and disease course. Positive anti-CCP antibody may be a risk factor for OP in RA patients. Calcium supplements and active vitamin D help prevent osteoporosis.