北京大学学报(医学版)
北京大學學報(醫學版)
북경대학학보(의학판)
Journal of Peking University (Health Sciences)
2015年
5期
774-780
,共7页
王昱%耿研%邓雪蓉%张卓莉
王昱%耿研%鄧雪蓉%張卓莉
왕욱%경연%산설용%장탁리
关节炎,类风湿%骨密度%腕关节%吸收测定法,光子%超声检查
關節炎,類風濕%骨密度%腕關節%吸收測定法,光子%超聲檢查
관절염,류풍습%골밀도%완관절%흡수측정법,광자%초성검사
Arthritis,rheumatoid%Bone density%Carpal joints%Absorptiometry,photon%Ultrasonography
目的:分析类风湿关节炎(rheumatoid arthritis,RA)患者手腕双能X线(dual-energy X-ray absorptiometry, DXA)检查结果,与关节超声影像学评分比较,以确定其与RA关节炎症以及骨侵蚀的相关性。方法:80名女性类风湿关节炎患者采用双能X线法检测非优势手腕部骨密度(bone mineral density, BMD)以及椎体、髋部骨密度,同时检测同侧以及双侧腕关节超声,扫描桡腕关节、中线腕骨间、尺腕关节,并分别记录腕关节滑膜增生、肌腱炎、骨侵蚀等情况,使用彩色多普勒进行关节炎评分。结果:(1)80名女性RA患者中,平均年龄(54.6±13.3)(27.0~80.0)岁,病程48(12~116)个月,体重指数(body mass index, BMI)(23.0±4.0)(14.8~31.2) kg/m2。 RA患者腕部BMD低于正常对照[(0.297±0.121)vs.(0.420±0.180) g/cm2,P<0.01]。(2)早期RA腕部骨密度高于长病程RA[(0.326±0.103) vs.(0.285±0.132) g/cm2,P<0.01],腕部严重骨质疏松发生率低于长病程RA(47.8% vs.64.9%,P<0.05),超声发现腕骨侵蚀发生率低于长病程 RA(39.1%vs.56.1%,P<0.01)。(3)高疾病活动度组腕关节骨密度低于中度活动以及缓解患者[(0.267±0.140) g/cm2 vs.(0.280±0.126) g/cm2,(0.267±0.140) g/cm2 vs.(0.320±0.103) g/cm2],差异均具有统计学意义(P<0.05)。高疾病活动度组RA患者与中度活动组患者抗环胍氨酸多肽抗体( anti-cyclic citrullinated peptide antibody ,ACPA)阳性比例分别为85%和92.6%,均高于缓解组患者81.8%,差异具有统计学意义(P<0.05)。患者DAS28ESR(disease activity score 28 joint count)与腕部BMD呈负相关(r=-0.288, P<0.01)。(4)RA患者腕部BMD与脊柱和髋部BMD均呈正相关(r=0.634,P<0.01,r=0.795,P<0.01);腕部BMD与疾病病程呈负相关(r=-0.286,P<0.01),与DAS28 ESR呈负相关(r=-0.301,P<0.01)。早期RA腕部BMD和髋部BMD呈正相关(r=0.95,P<0.05),且相关系数较高。(5)骨质疏松组患者类风湿因子(rheumatoid fac-tor,RF)、ACPA阳性比例高于骨量减少组(分别为75.5%vs.55.6%,P<0.05和100%vs.83.3%,P<0.05)。骨质疏松组RA患者疾病活动度DAS28ESR高于骨量减少组(5.3±1.8 vs.4.6±2.5,P<0.01)。骨质疏松组患者经超声探查发现腕部存在滑膜炎(61.5%vs.51.7%, P<0.05)、肌腱炎(14.3%vs.10.0%, P<0.05)以及骨侵蚀(54.2%vs.46.2%, P<0.05)的比例均高于骨量减少组,差异具有统计学意义。(6)超声发现腕部骨侵蚀患者与未见骨侵蚀患者相比,出现骨侵蚀患者手腕部BMD低于未见骨侵蚀患者[(0.333±0.107) g/cm2 vs.(0.264±0.125) g/cm2,P<0.01],滑膜炎多普勒评分高于未见骨侵蚀组(4.53±1.40 vs.2.55±2.66,P<0.01)。此外,与未见骨侵蚀组患者相比,出现骨侵蚀RA患者,病程更长[(96.0±104.7)月vs.(66.2±78.0)月, P<0.05],RF阳性率高(81.0% vs.53.8%,P<0.01)、ACPA抗体阳性率高(92.7% vs.79.5%,P<0.05),疾病活动度DAS28ESR更高(5.4±1.8 vs.4.2±2.0,P<0.05),出现同侧腕关节滑膜炎的比例更高(75.6%vs.30.8%,P<0.01),此外,同侧腕关节出现严重骨质疏松的比例更高(75.0%vs.46.4%,P<0.01),差异均具有统计学意义。(7)以骨密度值为结果变量,对影响患者骨密度值的因素进行多元回归分析显示,年龄(P=0.001)、病程(P=0.017)、DAS28ESR(P=0.021)以及ACPA (P=0.05)分别是造成患者手腕BMD异常的相关危险因素。结论:女性RA患者腕部BMD与疾病的病程以及炎症程度相关,ACPA抗体高滴度患者更容易出现骨密度下降。
目的:分析類風濕關節炎(rheumatoid arthritis,RA)患者手腕雙能X線(dual-energy X-ray absorptiometry, DXA)檢查結果,與關節超聲影像學評分比較,以確定其與RA關節炎癥以及骨侵蝕的相關性。方法:80名女性類風濕關節炎患者採用雙能X線法檢測非優勢手腕部骨密度(bone mineral density, BMD)以及椎體、髖部骨密度,同時檢測同側以及雙側腕關節超聲,掃描橈腕關節、中線腕骨間、呎腕關節,併分彆記錄腕關節滑膜增生、肌腱炎、骨侵蝕等情況,使用綵色多普勒進行關節炎評分。結果:(1)80名女性RA患者中,平均年齡(54.6±13.3)(27.0~80.0)歲,病程48(12~116)箇月,體重指數(body mass index, BMI)(23.0±4.0)(14.8~31.2) kg/m2。 RA患者腕部BMD低于正常對照[(0.297±0.121)vs.(0.420±0.180) g/cm2,P<0.01]。(2)早期RA腕部骨密度高于長病程RA[(0.326±0.103) vs.(0.285±0.132) g/cm2,P<0.01],腕部嚴重骨質疏鬆髮生率低于長病程RA(47.8% vs.64.9%,P<0.05),超聲髮現腕骨侵蝕髮生率低于長病程 RA(39.1%vs.56.1%,P<0.01)。(3)高疾病活動度組腕關節骨密度低于中度活動以及緩解患者[(0.267±0.140) g/cm2 vs.(0.280±0.126) g/cm2,(0.267±0.140) g/cm2 vs.(0.320±0.103) g/cm2],差異均具有統計學意義(P<0.05)。高疾病活動度組RA患者與中度活動組患者抗環胍氨痠多肽抗體( anti-cyclic citrullinated peptide antibody ,ACPA)暘性比例分彆為85%和92.6%,均高于緩解組患者81.8%,差異具有統計學意義(P<0.05)。患者DAS28ESR(disease activity score 28 joint count)與腕部BMD呈負相關(r=-0.288, P<0.01)。(4)RA患者腕部BMD與脊柱和髖部BMD均呈正相關(r=0.634,P<0.01,r=0.795,P<0.01);腕部BMD與疾病病程呈負相關(r=-0.286,P<0.01),與DAS28 ESR呈負相關(r=-0.301,P<0.01)。早期RA腕部BMD和髖部BMD呈正相關(r=0.95,P<0.05),且相關繫數較高。(5)骨質疏鬆組患者類風濕因子(rheumatoid fac-tor,RF)、ACPA暘性比例高于骨量減少組(分彆為75.5%vs.55.6%,P<0.05和100%vs.83.3%,P<0.05)。骨質疏鬆組RA患者疾病活動度DAS28ESR高于骨量減少組(5.3±1.8 vs.4.6±2.5,P<0.01)。骨質疏鬆組患者經超聲探查髮現腕部存在滑膜炎(61.5%vs.51.7%, P<0.05)、肌腱炎(14.3%vs.10.0%, P<0.05)以及骨侵蝕(54.2%vs.46.2%, P<0.05)的比例均高于骨量減少組,差異具有統計學意義。(6)超聲髮現腕部骨侵蝕患者與未見骨侵蝕患者相比,齣現骨侵蝕患者手腕部BMD低于未見骨侵蝕患者[(0.333±0.107) g/cm2 vs.(0.264±0.125) g/cm2,P<0.01],滑膜炎多普勒評分高于未見骨侵蝕組(4.53±1.40 vs.2.55±2.66,P<0.01)。此外,與未見骨侵蝕組患者相比,齣現骨侵蝕RA患者,病程更長[(96.0±104.7)月vs.(66.2±78.0)月, P<0.05],RF暘性率高(81.0% vs.53.8%,P<0.01)、ACPA抗體暘性率高(92.7% vs.79.5%,P<0.05),疾病活動度DAS28ESR更高(5.4±1.8 vs.4.2±2.0,P<0.05),齣現同側腕關節滑膜炎的比例更高(75.6%vs.30.8%,P<0.01),此外,同側腕關節齣現嚴重骨質疏鬆的比例更高(75.0%vs.46.4%,P<0.01),差異均具有統計學意義。(7)以骨密度值為結果變量,對影響患者骨密度值的因素進行多元迴歸分析顯示,年齡(P=0.001)、病程(P=0.017)、DAS28ESR(P=0.021)以及ACPA (P=0.05)分彆是造成患者手腕BMD異常的相關危險因素。結論:女性RA患者腕部BMD與疾病的病程以及炎癥程度相關,ACPA抗體高滴度患者更容易齣現骨密度下降。
목적:분석류풍습관절염(rheumatoid arthritis,RA)환자수완쌍능X선(dual-energy X-ray absorptiometry, DXA)검사결과,여관절초성영상학평분비교,이학정기여RA관절염증이급골침식적상관성。방법:80명녀성류풍습관절염환자채용쌍능X선법검측비우세수완부골밀도(bone mineral density, BMD)이급추체、관부골밀도,동시검측동측이급쌍측완관절초성,소묘뇨완관절、중선완골간、척완관절,병분별기록완관절활막증생、기건염、골침식등정황,사용채색다보륵진행관절염평분。결과:(1)80명녀성RA환자중,평균년령(54.6±13.3)(27.0~80.0)세,병정48(12~116)개월,체중지수(body mass index, BMI)(23.0±4.0)(14.8~31.2) kg/m2。 RA환자완부BMD저우정상대조[(0.297±0.121)vs.(0.420±0.180) g/cm2,P<0.01]。(2)조기RA완부골밀도고우장병정RA[(0.326±0.103) vs.(0.285±0.132) g/cm2,P<0.01],완부엄중골질소송발생솔저우장병정RA(47.8% vs.64.9%,P<0.05),초성발현완골침식발생솔저우장병정 RA(39.1%vs.56.1%,P<0.01)。(3)고질병활동도조완관절골밀도저우중도활동이급완해환자[(0.267±0.140) g/cm2 vs.(0.280±0.126) g/cm2,(0.267±0.140) g/cm2 vs.(0.320±0.103) g/cm2],차이균구유통계학의의(P<0.05)。고질병활동도조RA환자여중도활동조환자항배고안산다태항체( anti-cyclic citrullinated peptide antibody ,ACPA)양성비례분별위85%화92.6%,균고우완해조환자81.8%,차이구유통계학의의(P<0.05)。환자DAS28ESR(disease activity score 28 joint count)여완부BMD정부상관(r=-0.288, P<0.01)。(4)RA환자완부BMD여척주화관부BMD균정정상관(r=0.634,P<0.01,r=0.795,P<0.01);완부BMD여질병병정정부상관(r=-0.286,P<0.01),여DAS28 ESR정부상관(r=-0.301,P<0.01)。조기RA완부BMD화관부BMD정정상관(r=0.95,P<0.05),차상관계수교고。(5)골질소송조환자류풍습인자(rheumatoid fac-tor,RF)、ACPA양성비례고우골량감소조(분별위75.5%vs.55.6%,P<0.05화100%vs.83.3%,P<0.05)。골질소송조RA환자질병활동도DAS28ESR고우골량감소조(5.3±1.8 vs.4.6±2.5,P<0.01)。골질소송조환자경초성탐사발현완부존재활막염(61.5%vs.51.7%, P<0.05)、기건염(14.3%vs.10.0%, P<0.05)이급골침식(54.2%vs.46.2%, P<0.05)적비례균고우골량감소조,차이구유통계학의의。(6)초성발현완부골침식환자여미견골침식환자상비,출현골침식환자수완부BMD저우미견골침식환자[(0.333±0.107) g/cm2 vs.(0.264±0.125) g/cm2,P<0.01],활막염다보륵평분고우미견골침식조(4.53±1.40 vs.2.55±2.66,P<0.01)。차외,여미견골침식조환자상비,출현골침식RA환자,병정경장[(96.0±104.7)월vs.(66.2±78.0)월, P<0.05],RF양성솔고(81.0% vs.53.8%,P<0.01)、ACPA항체양성솔고(92.7% vs.79.5%,P<0.05),질병활동도DAS28ESR경고(5.4±1.8 vs.4.2±2.0,P<0.05),출현동측완관절활막염적비례경고(75.6%vs.30.8%,P<0.01),차외,동측완관절출현엄중골질소송적비례경고(75.0%vs.46.4%,P<0.01),차이균구유통계학의의。(7)이골밀도치위결과변량,대영향환자골밀도치적인소진행다원회귀분석현시,년령(P=0.001)、병정(P=0.017)、DAS28ESR(P=0.021)이급ACPA (P=0.05)분별시조성환자수완BMD이상적상관위험인소。결론:녀성RA환자완부BMD여질병적병정이급염증정도상관,ACPA항체고적도환자경용역출현골밀도하강。
Objective:To find the correlation of wrist bone mineral density ( BMD ) to wrist synovitis and erosion , by comparing wrist BMD and ultrasonography .Methods: A number of 80 female RA pa-tients were examined by BMD measurement of the femoral neck , spine and non-dominant wrist using du-al-energy X-ray absorptiometry ( DXA ) .Synovitis of the wrist was examined by ultrasonography .The wrist joint ( radiocarpal joint , dorsal midline , and carpoulnar joint ) was assessed in the same side of DXA, with transverse and longitudinal scans for USGS synovial hypertrophy and proliferation , tenosynovi-tis,tendinitis and bone erosion .Colour and power doppler ultrasonography ( PDUS) were used to sum the synovitis score .Results:We found:( 1 ) In the study , 80 female RA patients were enrolled , the mean age was 54.6 ±13.3 (27.0-80.0) years, the disease duration was 48 (12-116) months, and the body Mass Index was 23.0 ±4.0 (14.8-31.2) kg/m2 .The Wrist BMD ( g/cm2 ) in RA significantly reduced, compared with normal controls (0.297 ±0.121 vs.0.420 ±0.180,P<0.01).(2) The Wrist BMD (g/cm2) exceeded in early RA compared with the established RA (0.326 ±0.103 vs.0.285 ± 0 .132 ,P<0 .01 );the positive rate of severe osteoporosis in wrist was lower in early RA compared with the established RA(47.8%vs.64.9%, P<0.05); the positive rate of bone erosion in wrist by ultra-sound was lower in early RA compared with the established RA (39.1%vs.56.1%, P<0.01).(3) The wrist BMD ( g/cm2 ) in RA with high disease activity reduced compared with moderate and low disease activity (0.267 ±0.140 vs.0.280 ±0.126) and (0.267 ±0.140 vs.0.320 ±0.103) respec-tively , P<0 .05 ) .The percentages of positive ACPA in the high and moderate disease activity groups were significantly higher than those in the remission group (85% vs.81.8% and 92.6% vs.81.8%, respectively).DAS28ESR was correlated with wrist BMD (r=-0.288, P<0.01).(4) A significant positive correlation was found between wrist and spine /femur BMD ( r=0.634, P<0.01, r=0.795, P<0.01), and a negative correlation between wrist and disease duration and DAS 28ESR (r=-0.286, r=-0.301,P<0.01).There was a highly significant positive correlation between wrist BMD and femur BMD (r=0.95,P<0.05).(5) RA patients in wrist osteoporosis group had higher RF positive rate and ACPA rate than wrist osteopenia group (75.5%vs.55.6%,P<0.05,100% vs.83.3%, P<0.05). The patients of BMD osteoporosis group had higher DAS 28ESR compared with osteopenia group (5.3 ± 1.8 vs.3.7 ±1.5, P<0.01).The percentages of synovitis (61.5%vs.51.7%, P<0.05), tendeni-tis (14.3%vs.10.0%, P<0.05) and bone erosion (54.2%vs.46.2%, P<0.05) in wrist by ultra-sonography in osteoporosis group were higher than those of osteopenia group .(6) The wrist BMD in ne-gative bone erosion group by ultrasonography was lower than that in positive bone erosion group [ (0.333 ± 0.107) g/cm2 vs.(0.264 ±0.125) g/cm2, P<0.01], also the PDUS score was higher than positive bone erosion group (4.53 ±1.40 vs.2.55 ±2.66,P<0.01).Compared with negative bone erosion group, the patients in positive bone erosion group had longer disease duration (96.0 ±104.7) months vs.(66.2 ±78.0) months, P<0.05), higher percentage of RF (81.0% vs.53.8%,P<0.01), ACPA (92.7%vs.79.5%, P<0.05).and higher DAS28ESR (5.4 ±1.8 vs.4.2 ±2.0,P<0.05). The percentage of wrist synovitis in positive bone erosion group was higher (75.6% vs.30.8%,P<0.01) than that of negative bone erosion group , and moreover , the percentage of severe osteoporosis in the wrist was significantly higher (75.0%vs.46.4%, P<0.01).(7) A stepwise multivariate linear regression model was constructed to explore the relationship between the different clinical factors studied and a low wrist BMD.Statistically significant variables were age (P=0.001), disease duration (P=0.017), DAS28ESR (P=0.021), and ACPA (P=0.05).Conclusion:This study shows a highly sig-nificant correlation between hand BMD with disease duration and disease activity , and female RA patients with high titer of ACPA have lower wrist BMD .ABSTRACT Objective:To find the correlation of wrist bone mineral density ( BMD ) to wrist synovitis and erosion , by comparing wrist BMD and ultrasonography .Methods: A number of 80 female RA pa-tients were examined by BMD measurement of the femoral neck , spine and non-dominant wrist using du-al-energy X-ray absorptiometry ( DXA ) .Synovitis of the wrist was examined by ultrasonography .The wrist joint ( radiocarpal joint , dorsal midline , and carpoulnar joint ) was assessed in the same side of DXA, with transverse and longitudinal scans for USGS synovial hypertrophy and proliferation , tenosynovi-tis,tendinitis and bone erosion .Colour and power doppler ultrasonography ( PDUS) were used to sum the synovitis score .Results:We found:( 1 ) In the study , 80 female RA patients were enrolled , the mean age was 54.6 ±13.3 (27.0-80.0) years, the disease duration was 48 (12-116) months, and the body Mass Index was 23.0 ±4.0 (14.8-31.2) kg/m2 .The Wrist BMD ( g/cm2 ) in RA significantly reduced, compared with normal controls (0.297 ±0.121 vs.0.420 ±0.180,P<0.01).(2) The Wrist BMD (g/cm2) exceeded in early RA compared with the established RA (0.326 ±0.103 vs.0.285 ± 0 .132 ,P<0 .01 );the positive rate of severe osteoporosis in wrist was lower in early RA compared with the established RA(47.8%vs.64.9%, P<0.05); the positive rate of bone erosion in wrist by ultra-sound was lower in early RA compared with the established RA (39.1%vs.56.1%, P<0.01).(3) The wrist BMD ( g/cm2 ) in RA with high disease activity reduced compared with moderate and low disease activity (0.267 ±0.140 vs.0.280 ±0.126) and (0.267 ±0.140 vs.0.320 ±0.103) respec-tively , P<0 .05 ) .The percentages of positive ACPA in the high and moderate disease activity groups were significantly higher than those in the remission group (85% vs.81.8% and 92.6% vs.81.8%, respectively).DAS28ESR was correlated with wrist BMD (r=-0.288, P<0.01).(4) A significant positive correlation was found between wrist and spine /femur BMD ( r=0.634, P<0.01, r=0.795, P<0.01), and a negative correlation between wrist and disease duration and DAS 28ESR (r=-0.286, r=-0.301,P<0.01).There was a highly significant positive correlation between wrist BMD and femur BMD (r=0.95,P<0.05).(5) RA patients in wrist osteoporosis group had higher RF positive rate and ACPA rate than wrist osteopenia group (75.5%vs.55.6%,P<0.05,100% vs.83.3%, P<0.05). The patients of BMD osteoporosis group had higher DAS 28ESR compared with osteopenia group (5.3 ± 1.8 vs.3.7 ±1.5, P<0.01).The percentages of synovitis (61.5%vs.51.7%, P<0.05), tendeni-tis (14.3%vs.10.0%, P<0.05) and bone erosion (54.2%vs.46.2%, P<0.05) in wrist by ultra-sonography in osteoporosis group were higher than those of osteopenia group .(6) The wrist BMD in ne-gative bone erosion group by ultrasonography was lower than that in positive bone erosion group [ (0.333 ± 0.107) g/cm2 vs.(0.264 ±0.125) g/cm2, P<0.01], also the PDUS score was higher than positive bone erosion group (4.53 ±1.40 vs.2.55 ±2.66,P<0.01).Compared with negative bone erosion group, the patients in positive bone erosion group had longer disease duration (96.0 ±104.7) months vs.(66.2 ±78.0) months, P<0.05), higher percentage of RF (81.0% vs.53.8%,P<0.01), ACPA (92.7%vs.79.5%, P<0.05).and higher DAS28ESR (5.4 ±1.8 vs.4.2 ±2.0,P<0.05). The percentage of wrist synovitis in positive bone erosion group was higher (75.6% vs.30.8%,P<0.01) than that of negative bone erosion group , and moreover , the percentage of severe osteoporosis in the wrist was significantly higher (75.0%vs.46.4%, P<0.01).(7) A stepwise multivariate linear regression model was constructed to explore the relationship between the different clinical factors studied and a low wrist BMD.Statistically significant variables were age (P=0.001), disease duration (P=0.017), DAS28ESR (P=0.021), and ACPA (P=0.05).Conclusion:This study shows a highly sig-nificant correlation between hand BMD with disease duration and disease activity , and female RA patients with high titer of ACPA have lower wrist BMD .