CAJ | 학술논문

目的：调查类风湿关节炎（RA）患者骨密度（BMD），并探讨骨流失的相关危险因素。方法采用横断面方法调查102例绝经后女性、50岁以上男性RA患者及经年龄、性别匹配的47例对照人群腰椎、前臂、股骨颈、全髋关节四个部位的 BMD，记录患者基本资料及用药情况。根据病程分为早期RA组（≤6个月）及非早期RA组（＞6个月），比较对照组、总RA患者、早期RA、非早期RA各部位BMD 的变化情况及各组间骨质疏松症、骨量低下的发病率，并分析与之相关的危险因素。结果（1）早期RA患者ESR、DAS28评分、糖皮质激素使用率、使用量等明显高于非早期RA患者组，而抗骨质疏松药物的使用率等则显著低于病史长者（P＜0.05）。（2）除对照组与早期RA患者OP率、骨量低下率和早期RA与非早期RA患者OP率差异不显著外，其余各组数据均有显著性差异（P＜0.05）。（3）RA总体及非早期RA患者各部位BMD较对照组均明显下降；而早期RA与对照组相比，仅前臂BMD下降明显；两组RA患者除前臂差异不显著外，其余各部位BMD差异均有统计学意义（P＜0.05）。（4）病程、绝经年限、ESR、CRP、活性维生素D及骨吸收抑制剂的应用与各部位BMD变化相关，DAS28与股骨颈、髋关节BMD变化相关，而糖皮质激素、DMARDs使用等因素与BMD变化无显著相关。结论 RA是继发性骨质疏松症的重要原因，开始于四肢骨逐渐发展至全身，疾病活动度和关节功能障碍造成的活动障碍等是骨流失的危险因素，应用骨营养剂及骨吸收抑制剂能有效防治骨破坏。
목적：조사류풍습관절염（RA）환자골밀도（BMD），병탐토골류실적상관위험인소。방법채용횡단면방법조사102례절경후녀성、50세이상남성RA환자급경년령、성별필배적47례대조인군요추、전비、고골경、전관관절사개부위적 BMD，기록환자기본자료급용약정황。근거병정분위조기RA조（≤6개월）급비조기RA조（＞6개월），비교대조조、총RA환자、조기RA、비조기RA각부위BMD 적변화정황급각조간골질소송증、골량저하적발병솔，병분석여지상관적위험인소。결과（1）조기RA환자ESR、DAS28평분、당피질격소사용솔、사용량등명현고우비조기RA환자조，이항골질소송약물적사용솔등칙현저저우병사장자（P＜0.05）。（2）제대조조여조기RA환자OP솔、골량저하솔화조기RA여비조기RA환자OP솔차이불현저외，기여각조수거균유현저성차이（P＜0.05）。（3）RA총체급비조기RA환자각부위BMD교대조조균명현하강；이조기RA여대조조상비，부전비BMD하강명현；량조RA환자제전비차이불현저외，기여각부위BMD차이균유통계학의의（P＜0.05）。（4）병정、절경년한、ESR、CRP、활성유생소D급골흡수억제제적응용여각부위BMD변화상관，DAS28여고골경、관관절BMD변화상관，이당피질격소、DMARDs사용등인소여BMD변화무현저상관。결론 RA시계발성골질소송증적중요원인，개시우사지골축점발전지전신，질병활동도화관절공능장애조성적활동장애등시골류실적위험인소，응용골영양제급골흡수억제제능유효방치골파배。
Objective Investigate the bone mineral density of rheumatoid arthritis, and discusses the related risk factors. Methods A cross-sectional research test BMD(lumbar spine, forearm, femoral neck, total hip) and record patients' basic information. The research includes 102 RA patients who are postmenopausal women and men over the age of 50 and 47 cases matched by age, sex for control group. According to the course of the disease, RA can be divided into early RA (≤6 months) and established RA (>6 months), we compare BMD, the morbidity of osteoporosis and osteopenia among control group , RA, early RA and established RA. Results (1) ESR, DAS28 score and the use of glucocorticoid in early RA were much higher than in established RA, oppositely, the use of anti-osteoporosis drug was lower(P<0.05). (2) Except the difference of the morbidity of osteoporosis and osteopenia between the control group and early RA, and the morbidity of osteoporosis between the control group and early RA were not significant, the difference between other groups was statistically significant (P<0.05). (3) Each parts BMD in the control group were much higher than RA and established RA. Between early RA and the control group, only the forearm BMD declined significantly. However, the difference between early RA and established RA, except the forearm BMD was not significant, other parts were statistically significant all (P<0.05). (4) The related factors with each part BMD were the course of disease, course of disease, ESR, CRP, the use of activated vitamin D and bone resorption inhibitor. DAS28 score was associated with BMD of femoral neck and total hip. The use of glucocorticoid and DMARDs were not related with the changes of BMD. Conclusion RA is the important reason for the secondary osteoporosis, BMD decline begin with limbs, gradually developed to the trunk. Disease activity and joint dysfunction caused by inactivity is the risk factors for BMD loss, however, application of bone nutrients and bone resorption inhibitor can effectively prevent the bone destruction.