强直性脊柱炎骨质疏松30例临床分析

Osteoporosis in patients with ankylosing spondylitis

目的 研究强直性脊柱炎 (AS)骨质疏松的发生情况、相关因素及与骨代谢指标的关系。方法 3 0例AS患者及对照组 2 0例 ,用双能X线吸收法 (DEXA)测定腰椎、股骨颈骨密度 (BMD) ,用酶联免疫法测定血清骨钙素 (BGP)、骨碱性磷酸酶 (BAP)及尿脱氧吡啶胶原交联 (D Pyr)。结果 AS早期腰椎及股骨颈BMD均较对照组低 ,而晚期椎体周围软组织骨化使腰椎BMD增加 ,但股骨颈BMD仍低于对照组。 3 0例AS中共有 6例骨质疏松 ,10例骨量减少。AS的股骨颈BMD与病程、ESR、CRP、X线分期呈负性相关 ,绝经前女性BMD变化不如男性明显 ,HLA B2 7阳性与阴性患者BMD无明显差异。AS骨质疏松组 ,骨形成的指标BGP、BAP与对照组无明显差异 ,骨吸收的指标D Pyr明显增高。结论 AS继发全身性骨质疏松并不少见 ,其发生与病程、疾病活动指标、疾病严重程度相关 ,AS骨质疏松主要与骨吸收增加有关。

Objectives To study the frequency and risk factors of osteoporosis,and the relationship between bone turnover makers and bone mineral density (BMD) in patients with ankylosing spondylitis (AS).Methods BMD in the spine and femoral neck was measured with dual-energy x-ray absorptiometry (DEXA) in 30 AS patients. Enzyme linked immunoassay was used to measure serum bone gla protein (BGP), bone-specific alkalin phosphtase (BAP), and urine deoxypyridinoline crosslinks (D Pyr).Results The patients in early stage lost the bone mass already.They had lower volume of BMD in both hip and spines than that of controls. But in the later stage,the BMD of spines was higher than that of the control group because of the calcification of the surrounding tissues of the spine.While even the BMD of femoral neck was still lower than that of normal subjects. Osteoporosis was observed in 6 patients, osteopenia in 10. Osteoporosis in AS correlated negatively with the disease duration, ESR, CRP, and X ray grades. The reduction in BMD in premenopausal women with early AS was slighter than that in men. The BMD had no significant differences in HLA B 27 (+) patients and HLA B 27 (-)patients. BGP and BAP which reflect bone formation had no differences in AS patients and controls. D Pyr which reflects bone resorption was significantly increased compared with controls.Conclusions Osteoporosis in AS is common and may be related to disease duration and severity. A significant increase in bone resorption is observed in AS with osteoporosis.