1061例类风湿关节炎患者骨密度及相关危险因素分析

Analysis of bone mineral density and risk factors in 1061 cases of rheumatoid arthritis

目的 通过对1 061例类风湿关节炎(RA)患者骨密度(BMD)及相关临床因素的分析,探讨RA合并骨质疏松症(OP)的影响因素。方法 选取2016年1月至2020年8月于我院确诊的1 061例RA患者,同期健康体检者636例,使用双能X线骨密度检测仪检测腰椎1~4、左股骨近端骨密度,收集RA患者一般资料,评估疾病活动度评分(DAS28评分),检测抗环瓜氨酸肽抗体(抗CCP抗体)、类风湿因子(RF)、血沉、C-反应蛋白,分析RA患者骨密度及相关危险因素。结果 RA组股骨颈、股骨转子、转子间、全髋关节、腰椎1~4、全部腰椎骨密度较对照组均减低(P<0.001),低骨量、骨质疏松占比分别为36.5%、30.7%,较对照组高(P<0.001)。RA是OP的独立危险因素,OR值为2.30(1.70~3.09),BMI是RA合并OP的保护因素,OR值为0.82(0.77~0.86),年龄、女性、服用糖皮质激素大于1个月、脆性骨折史、股骨头坏死是RA合并OP的独立危险因素,OR值分别为1.14(1.12~1.16)、4.83(3.05~7.64)、2.31(1.57~3.41)、6.90(2.28~20.88)、16.19(3.20~81.90)。抗CCP抗体、RF、DAS28评分非RA合并OP的危险因素。结论 RA较健康人群骨密度显著减低,罹患OP风险增加,对高龄、女性、长病程、低体重、有脆性骨折史、股骨头坏死、使用糖皮质激素的患者尤其需要警惕骨质疏松的发生。

Objective To investigate risk factors of rheumatoid arthritis(RA) combined with osteoporosis(OP) by analysis of bone mineral density(BMD) and related clinical factors in 1061 patients with RA. Methods A total of 1061 RA patients diagnosed in our hospital from January 2016 to August 2020 were selected and 636 healthy subjects were examined during the same period. BMD of the lumbar spine 1 to 4 and left proximal femur were detected with dual-energy X-ray. RF, erythrocyte sedimentation rate, C-reactive protein, and anti-CCP antibody were detected. General data of RA patients were collected. ResultsBMD of the femoral neck, femoral trochanter, intertrochanter, total hip joint, 1 to 4 lumbar spine, and all lumbar vertebra in RA group were lower(P<0.001), and the proportion of low bone mass and osteoporosis were 36.5% and 30.7% higher(P<0.001), respectively, than those in the control group. RA was an independent risk factor for OP and the OR value was 2.30(1.70-3.09). BMI was a protective factor for RA combined with OP and the OR value was 0.82(0.77-0.86). Age, female, glucocorticoid use for more than 1 month, history of fragility fracture, and necrosis of femoral head were independent risk factors for RA combined with OP, with OR values of 1.14(1.12-1.16), 4.83(3.05-7.64), 2.31(1.57-3.41), 6.90(2.28-20.88), and 16.19(3.20-81.90), respectively. Anti-CCP antibody, RF, and DAS28 scores were not risk factors of RA combined with OP. ConclusionBMD in RA patients is significantly lower than that in healthy people. The risk of OP in RA patients increases. It is especially necessary to pay attention to the occurrence of osteoporosis in patients with elder age, female gender, long course of disease, low body weight, fragility fracture history, femoral head necrosis, and the use of glucocorticoids.