CAJ | 학술논문

目的探讨类风湿关节炎(RA)患者全身骨质疏松和局部骨侵蚀的相关性.方法采用双能X线骨密度测定仪(DEXA)法测定120例RA患者和120名健康者的股骨(股骨颈、Ward区、大转子)和腰椎(腰椎2～4)部位骨密度,详细记录RA患者各临床及实验室指标,并对其中76例RA患者的双手X线进行Sharp评分.采用t检验和x2检验进行统计学分析.结果 ①和健康对照组相比,RA患者在总股骨区、腰椎2、3、4和腰椎2～4部位骨密度明显降低(P＜0.01),而股骨颈、Ward和大转子区骨密度在2组间差异无统计学意义(P＞0.05).②RA组骨质疏松发生率34.2％(41/120)明显高于健康对照组15.0％(18/120) (x2=11.889,P=0.001).③RA患者中无骨质疏松和有骨质疏松组间在年龄[(49±11)与(58±13)岁,t=5.437,P＜0.01]、健康状况问卷(HAQ)(1.4±0.7与1.7±0.7,=2.067,P=0.041)、X线关节间隙狭窄评分(24±23与43±32,t=2.705,P=0.010)、X线骨侵蚀评分(20±24与41 ±36,t=2.786,P=0.008)、Sharp评分(43±47与84±66,t=2.821,P=0.007)上差异有统计学意义,而其他临床及实验室指标在2组间差异无统计学意义(P＞0.05).④相关性分析显示:RA患者各部位骨密度(总的腰椎2～4部位骨密度除外)均与Sharp评分呈负相关(P＜0.05).Logistic回归分析发现:年龄(OR=1.069,P=0.012,95％CI:1.015～1.125)和Sharp评分(OR=1.022,P=0.003,95％CI:1.007～1.037)为RA患者发生骨质疏松的危险因素,使用改善病情抗风湿药(OR=0.172,P=0.041,95％CI:0.032～0.930)是RA患者发生骨质疏松的保护因素.结论 RA患者骨密度明显降低,其骨质疏松发生率明显升高,且与年龄和局部骨侵蚀密切相关.
목적 탐토류풍습관절염(RA)환자전신골질소송화국부골침식적상관성.방법 채용쌍능X선골밀도측정의(DEXA)법측정120례RA환자화120명건강자적고골(고골경、Ward구、대전자)화요추(요추2～4)부위골밀도,상세기록RA환자각림상급실험실지표,병대기중76례RA환자적쌍수X선진행Sharp평분.채용t검험화x2검험진행통계학분석.결과 ①화건강대조조상비,RA환자재총고골구、요추2、3、4화요추2～4부위골밀도명현강저(P＜0.01),이고골경、Ward화대전자구골밀도재2조간차이무통계학의의(P＞0.05).②RA조골질소송발생솔34.2％(41/120)명현고우건강대조조15.0％(18/120) (x2=11.889,P=0.001).③RA환자중무골질소송화유골질소송조간재년령[(49±11)여(58±13)세,t=5.437,P＜0.01]、건강상황문권(HAQ)(1.4±0.7여1.7±0.7,=2.067,P=0.041)、X선관절간극협착평분(24±23여43±32,t=2.705,P=0.010)、X선골침식평분(20±24여41 ±36,t=2.786,P=0.008)、Sharp평분(43±47여84±66,t=2.821,P=0.007)상차이유통계학의의,이기타림상급실험실지표재2조간차이무통계학의의(P＞0.05).④상관성분석현시:RA환자각부위골밀도(총적요추2～4부위골밀도제외)균여Sharp평분정부상관(P＜0.05).Logistic회귀분석발현:년령(OR=1.069,P=0.012,95％CI:1.015～1.125)화Sharp평분(OR=1.022,P=0.003,95％CI:1.007～1.037)위RA환자발생골질소송적위험인소,사용개선병정항풍습약(OR=0.172,P=0.041,95％CI:0.032～0.930)시RA환자발생골질소송적보호인소.결론 RA환자골밀도명현강저,기골질소송발생솔명현승고,차여년령화국부골침식밀절상관.
Objective To investigate the relationship between the general osteoporosis and local bone erosion in patients with rheumatoid arthritis (RA).Methods Bone mineral density (BMD) of femur (femur neck,Ward area,greater trochanter) and lumbar spine 2-4 (L2-4) by dual energy X-ray absorptiometry was measured in 120 patients with RA and 120 normal controls.All the clinical and laboratory factors of RA were recorded in details,and the radiographic changes in both hands of 76 RA patients were assessed by Sharp'method.Statistical anylysis was carried out by using t test and x2 test.Results ① Compared with normal controls,the BMD of total femur,L2,L3,L4 and L2-4 decreased significantly (P＜0.01),while there was no significant differences in the BMD of femur neck,Ward area and greater trochanter between the two groups (P＞0.05).② The incidence of osteoporosis in RA (34.2％) was higher than that in normal controls (15.0％)(x2=11.889,P=0.001).③ Patients with osteoporosis had elder age,higher scores of HAQ,higher scores of space narrowing and bone erosion of joint by X-ray' Sharp method than those of patients without osteoporosis.There were no significant differences in the changes of other clinical and laboratory parameters between the two groups(P＞0.05).④ BMD of total femur,femur neck,Ward area,greater trochanter,L2,L3,L4 correlated with Sharp scores in RA and had shown a negative correlations(P＜0.05).Logistic regression analysis showed that age(OR=1.069,P=0.012,95％CI:1.015-1.125) and Sharp scores(OR=1.022,P=0.003,95％CI:1.007-1.037) were risk factors for osteoporosis in RA patients,but treating with DMARD (OR=0.172,P=0.041,95％CI:0.032-0.930) was a protective factor for osteoporosis in patients with RA.Conclusion The BMD decreases significantly and correlates with age and local bone erosion in patients with RA,while the incidence of osteoporsis increases remarkably.