女性类风湿关节炎患者骨密度变化的影响因素
Factors associated with the change of bone mineral density in female patients with rheumatoid arthritis
-
摘要: 目的:探讨女性类风湿关节炎(RA)患者骨质疏松(OP)的危险因素及其与临床指标的相关性。方法:使用双能X线骨密度仪测定115例女性RA患者和101名健康女性L1～L4、股骨颈、全髋等部位骨密度(BMD), 并观察患者的疾病活动指标和实验室指标。结果:女性RA患者患OP发生率高于健康女性(P0. 01), 其各部位BMD均低于对照组(P0. 05～P0. 01)。OP组RA患者各部位BMD均明显低于非OP组(P0. 01)。OP组患者年龄更大、绝经年数更长、病程和晨僵时间更长、疼痛关节数更多、HAQ平均积分更高、关节功能和X线分期更差(P0. 05～P0. 01)。RA组OP性骨折的概率明显高于健康女性(P0. 01), 使用糖皮质激素的RA患者第L1～L4的BMD低于未使用患者(P0. 05)。Logistic Regression分析显示绝经[OR=4. 582(1. 503～13. 974), P0. 01]和X线分期[OR=2. 267(1. 233～4. 167), P0. 01]为RA患者OP发生的主要危险因素。结论:女性RA患者发生OP和骨折风险均显著高于健康女性, 其OP的发生和多因素相关, 绝经年数更长、X线分期较差、使用糖皮质激素是RA患者发生OP的主要危险因素。Abstract: Objective: To study the risk factors of osteoporosis(OP) in female patients with rheumatoid arthritis(RA) , and the related clinical factors. Methods: The bone mineral density(BMD) of the lumbar vertebrae(L1-L4) , femoral neck and total femoral of 115 female patients with RA and 101 female healthy subjects area were measured by dual energy X-ray absorptiometry; and the clinical and laboratory indexes were observed in the meantime. Results: The incidence of OP in female patients with RA was significant higher than that in healthy subjects(P ＜ 0. 01) . The BMD of all positions in female patients with RA was lower than that in healthy subjects(P ＜ 0. 05-P ＜ 0. 01) . The RA patients diagnosed as having OP had lower BMD than those having not(P ＜ 0. 01) . The former had elder ages, longer years of menopause, longer duration of disease and morning stiffness, tender joint counts, higher HAQ scores and worse function of joint and X-ray status than the latter(P ＜ 0. 05-P ＜ 0. 01) . The osteoporotic fracture probability in patients with RA was obviously higher than that in healthy subjects in the next 10 years(P ＜ 0. 01) . The BMD of L1-L4 in female patients with RA who were taking corticosteroid was lower than that of patients taking no corticosteroid(P ＜ 0. 05) . Logistic regression analysis showed that menopause[OR = 4. 582(1. 503-13. 974) , P ＜ 0. 01］and X-ray status[OR = 2. 267(1. 233-4. 167) , P ＜ 0. 01) were the main risk factors for the OP in female patients with RA. Conclusions: Compared with the healthy subjects, the incidence of OP and the risk of osteoporotic fracture in female patients with RA rise apparently. The occurrence of OP is related with several risk factors, such as menopause, worse X-ray status and taking corticosteroid.
-
Key words:
- rheumatoid arthritis /
- bone mineral density /
- osteoporosis
-
[2] .Nampei A,Hashimoto J,Koyanagi J,et al.Characteristics of fracture and related factors in patients with rheumatoid arthritis[J].Mod Rheumatol,2008,18(2):170-176. [2] .张乃峥.类风湿关节炎[M].//张乃峥.临床风湿病学.上海:上海科学技术出版社.1999:118-140. [3] .周惠琼,姚如愚,Will RK.绝经后女类风湿关节炎患者骨密度变化影响因素分析[J].中日友好医院学报,2007,2l(3):131-134. [4] .臧谋圣,张林杰,徐胜前,等.绝经后女性类风湿关节炎患者骨密度的临床研究[J].临床军医杂志,2008,36(6):879-881. [5] .Haugeberg G,Uhlig T,Falch JA,et al.Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis:results from 394 patients in the Olso County Rheumatoid Arthritis register[J].Arthritis Rheum,2000,43(3):522-530. [6] .Kearns AE,Khosla S,Kostenuik PJ.Receptor activator of nuclear factor kappaB ligand and osteoprotegerin regulation of bone remodeling in health and disease[J].Endocr Rev,2008,29(2):155-192. [7] .Olama SM,Senna MK,Elarman M.Synovial/Serum leptin ratio in rheumatoid arthritis:the association with activity and erosion[J].Rheumatol Int,2012,32(3):683-690. [8] .臧谋圣,王玉,徐胜前,等.瘦素和可溶性瘦素受体在类风湿关节炎中的变化及其与骨质疏松的关系研究[J].中华风湿病学杂志,2010,14(1):44-47. [9] .徐胜前,邵宜波,徐建华.女性类风湿关节炎患者骨密度的研究[J].中国骨质疏松杂志,2004,10(1):69-72. [10] .周惠琼,姚如愚,Will RK.类风湿关节炎患者骨密度与疾病活动相关性的临床观察[J].中国骨质疏松杂志,2007,13(6):419-421. [11] .Solomon DH,Finkelstein JS,Shadick N,et al.The relationship between focal erosions and generalized osteoporosis in postmenopausal women with rheumatoid arthritis[J].Arthritis Rheum,2009,60(6):1624-1631. [12] .Suzuki Y,Mizushima Y.Osteoporosis in rheumatoid arthritis[J].Osteoporos Int,1997,7(3):217-222. [13] .周毅,梁志昂,林庆衍,等.短期小剂量激素治疗中老年类风湿性关节炎对患者骨密度的影响[J].广东医学,2006,27(6):847-848. [14] .Sambrook PN,Jones G.Corticosteroid osteoporosis[J].Br J Rheumatol,1995,34(1):8-12. [15] .Kanis JA,McCloskey EV,Johansson H,et al.Case finding for the management of osteoporosis with FRAX-assessment and intervention thresholds for the UK[J].Osteoporos Int,2008,19(10):1395-1408. [16] .Dawson-Hughes B,Tosteson AN,Melton LJ 3rd,et al.Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA[J].Osteoporos Int,2008,19(4):449-458. -
点击查看大图
计量
- 文章访问数: 2741
- HTML全文浏览量: 404
- PDF下载量: 120
- 被引次数: 0
下载:
