CAJ | 학술논문

目的分析住院类风湿关节炎(RA)患者骨质疏松和骨质疏松性骨折(OPF)的发生情况和临床危险因素.方法收集2010-2011年确诊的住院RA患者272例,以X线片作为判断骨折的标准,采用双能量X射线骨密度测量仪(DEXA)测定203例RA患者和120名健康人股骨和腰椎的骨密度,同时详细记录RA患者各临床及实验室指标,并对其中169例RA患者的双手X线进行Sharp评分.采用t检验、Mann-Whitney检验、x2检验和多元Logistic回归进行统计学处理.结果 ①和健康对照组相比,RA患者在股骨和腰椎部位骨密度均明显降低(P＜0.01),其骨质疏松发生率32.0％(65/203)明显高于健康对照组15.0％(18/120)(x2=11.442,P=0.001).272例RA患者中发生OPF的患者33例,发生率为12.1％;OPF组RA股骨区各部位骨密度较无OPF组明显降低(P＜0.01),但腰椎各部位骨密度差异无统计学意义(P＞0.05).②服用糖皮质激素(GC)的RA患者中骨质疏松发生率为42.2％(46/109),高于未服用GC组中的20.2％(18/89)(x210.818,P=0.001)；服用GC的RA患者中OPF发生率为17.5％(24/137),高于未服用GC组中的7.2％(9/125)(x26.321,P=0.012).③多元Logistic回归分析发现:年龄[OR=1.050,P=0.001,95％CI(1.020,1.080)]、HAQ[OR=1.966,P=0.031,95％CI(1.064,3.631)]和GC日剂量[OR=1.075,P=0.031,95％CI(1.007,1.148)]为RA患者发生骨质疏松的危险因素；而年龄[OR=1.041,P=0.046,95％CI(1.001,1.084)]和骨质疏松[OR=3.484,P=0.016,95％CI(1.258,9.646)]为RA患者发生OPF的危险因素.结论 RA患者骨质疏松和OPF发生率明显升高,且与年龄、RA疾病活动性和局部骨侵蚀、GC的使用密切相关.
목적 분석주원류풍습관절염(RA)환자골질소송화골질소송성골절(OPF)적발생정황화림상위험인소.방법 수집2010-2011년학진적주원RA환자272례,이X선편작위판단골절적표준,채용쌍능량X사선골밀도측량의(DEXA)측정203례RA환자화120명건강인고골화요추적골밀도,동시상세기록RA환자각림상급실험실지표,병대기중169례RA환자적쌍수X선진행Sharp평분.채용t검험、Mann-Whitney검험、x2검험화다원Logistic회귀진행통계학처리.결과 ①화건강대조조상비,RA환자재고골화요추부위골밀도균명현강저(P＜0.01),기골질소송발생솔32.0％(65/203)명현고우건강대조조15.0％(18/120)(x2=11.442,P=0.001).272례RA환자중발생OPF적환자33례,발생솔위12.1％;OPF조RA고골구각부위골밀도교무OPF조명현강저(P＜0.01),단요추각부위골밀도차이무통계학의의(P＞0.05).②복용당피질격소(GC)적RA환자중골질소송발생솔위42.2％(46/109),고우미복용GC조중적20.2％(18/89)(x210.818,P=0.001)；복용GC적RA환자중OPF발생솔위17.5％(24/137),고우미복용GC조중적7.2％(9/125)(x26.321,P=0.012).③다원Logistic회귀분석발현:년령[OR=1.050,P=0.001,95％CI(1.020,1.080)]、HAQ[OR=1.966,P=0.031,95％CI(1.064,3.631)]화GC일제량[OR=1.075,P=0.031,95％CI(1.007,1.148)]위RA환자발생골질소송적위험인소；이년령[OR=1.041,P=0.046,95％CI(1.001,1.084)]화골질소송[OR=3.484,P=0.016,95％CI(1.258,9.646)]위RA환자발생OPF적위험인소.결론 RA환자골질소송화OPF발생솔명현승고,차여년령、RA질병활동성화국부골침식、GC적사용밀절상관.
Objective To investigate the clinical features and related risk factors of osteoporosis (OP) and osteoporotic fracture (OPF) in patients with rheumatoid arthritis (RA).Methods Two hundred and seventytwo in-patients with RA between 2010-2011 were surveyed,X-ray was detected for the diagnosis of fracture.Bone mineral density(BMD) of proximal femur and lumbar vertebrae (L2-4) in 203 patients were measured by dual energy X-ray absorptio-metry (DEXA),and the radiographic changes in both hands of 169 RA patients were assessed by Sharp scoring system.All the clinical and laboratory factors of RA were recorded in detail by rheumatologists.The results of 120 normal people were used as controls.T-test,Mann-whitney test,x2 test and Logistic regression were used for statistical analysis.Results ① Compared to the normal group,the BMDs of RA patients at each measured location were significantly lower (P＜0.01),the OP incidence was 32.0％ (65/203),which was significantly higher than that of the normal group,which was 15.0％ (18/120) (x2=11.442,P=0.001).There were 33 cases of OPF among all 272 RA patients,and the occurrence rate was 12.1％.BMDs of the femur in RA with OPF were lower than those in RA without OPF (P＜0.01).② Incidence of OP in RA with glucoco-rticoid was 42.2％(46/109),which was higher than that in RA without glucocorticoid (20.2％,18/89) (x2=10.818,P=0.001).Compared with RA without glucocorticoid,the incidence of OPF in RA with glucocorticoid elevated evidently [7.2％ (9/125) vs 17.5％ (24/137)] (x2=6.321,P=0.012).③ Logistic regression (back-ward LR method) analysis found that the risk factors for OP in RA patients were age [OR=1.050,P=0.001,95％CI(1.020,1.080)],HAQ [OR=1.966,P=0.031,95％CI (1.064,3.631)],and glucocorticoid average daily dosage [OR=1.075,P=0.031,95％CI (1.007,1.148)].The risk factors for OPF in RA patients were age [OR=1.041,P=0.046,95％CI (1.001,1.084)] and OP [OR=3.484,P=0.016,95％CI (1.258,9.646)].Conclusion RA patients have higher incidence of OP and OPF than general population.The incidence of OP and OPF are closely correlated with age,diseases activity,local bone erosion and the use of glucocorticosteroid.