CAJ | 학술논문

目的分析维生素D缺乏和跌倒对RA患者发生脊柱骨质疏松性骨折(OPF)的影响.方法收集确诊RA患者852例,拍摄脊柱正侧位X线,测定体内25羟维生素D[25(OH)D]水平及骨密度,记录其他临床及实验室指标等.收集同期156名健康人作为对照组.采用t检验、x2检验、单因素方差分析、线性相关分析及Logistic回归进行统计分析.结果 ①RA患者脊柱OPF的发生率为16.1％(137/852),发生脊柱OPF的RA患者25 (OH)D水平低于无OPF组[(14±4) ng/ml,(18±7) ng/ml,t=2.898,P=0.004].②RA患者跌倒的发生率为19.7％(36/183),发生跌倒的RA患者25(OH)D水平低于无跌倒组[(14±4) ng/ml,(18±6) ng/ml,t=2.854,P=0.005].③发生脊柱OPF的RA患者跌倒发生率高于未发生脊柱OPF组(分别为38.1％,14.2％,x2=11.708,P=0.001).④线性相关分析:RA患者25(OH)D水平与总腰椎区骨密度呈正直线相关.⑤Logistic回归分析显示:年龄[OR=1.124,P=0.002,95％ CI(1.045,1.209)]和糖皮质激素[OR =6.724,P=0.031,95％CI:(1.196,37.813)]为RA患者发生脊柱OPF的危险因素,25(OH)D为保护因素[OR=0.850,P=0.046,95％CI: (0.725,0.997)].结论 RA患者脊柱OPF的发生与维生素D缺乏和跌倒、糖皮质激素密切相关.
목적 분석유생소D결핍화질도대RA환자발생척주골질소송성골절(OPF)적영향.방법 수집학진RA환자852례,박섭척주정측위X선,측정체내25간유생소D[25(OH)D]수평급골밀도,기록기타림상급실험실지표등.수집동기156명건강인작위대조조.채용t검험、x2검험、단인소방차분석、선성상관분석급Logistic회귀진행통계분석.결과 ①RA환자척주OPF적발생솔위16.1％(137/852),발생척주OPF적RA환자25 (OH)D수평저우무OPF조[(14±4) ng/ml,(18±7) ng/ml,t=2.898,P=0.004].②RA환자질도적발생솔위19.7％(36/183),발생질도적RA환자25(OH)D수평저우무질도조[(14±4) ng/ml,(18±6) ng/ml,t=2.854,P=0.005].③발생척주OPF적RA환자질도발생솔고우미발생척주OPF조(분별위38.1％,14.2％,x2=11.708,P=0.001).④선성상관분석:RA환자25(OH)D수평여총요추구골밀도정정직선상관.⑤Logistic회귀분석현시:년령[OR=1.124,P=0.002,95％ CI(1.045,1.209)]화당피질격소[OR =6.724,P=0.031,95％CI:(1.196,37.813)]위RA환자발생척주OPF적위험인소,25(OH)D위보호인소[OR=0.850,P=0.046,95％CI: (0.725,0.997)].결론 RA환자척주OPF적발생여유생소D결핍화질도、당피질격소밀절상관.
Objective To explore the effect of vitamin D deficiency and falls on osteoporotic fracture (OPF) in patients with rheumatoid arthritis (RA).Methods A total of 852 patients with RA were recruited, anteroposterior and lateral X-rays examination of vertebral column were conducted for every patient.Serum 25-hydroxy vitamin D [25(OH)D] levels and bone mineral density (BMD) of all the vertebrae of lumbar were exam-ined.Clinical and laboratory index of patients were recorded in details meanwhile.Data of 156 normal subjects during the same period were collected as the control group.Numerical data and categorical data comparisons were analyzed using t test, x2 test, single factor analysis of variance test, linear correlation and Logistic regression analysis test.Results ① The prevalence of vertebral OPF in RA was 16.1％(137/852).Compared to RA without OPF, patients with OPF had lower serum 25(OH)D levels [(14±4) ng/ml vs (18±7) ng/ml, t=2.898, P=0.004].② The occurrence rate of falls in RA patients was 19.7％(36/183).Patients with falls had lower serum 25(OH)D levels [(14±4) ng/ml vs (18±6) ng/ml, t=2.854, P=0.005].③ The prevalence of falls in RA with vertebral OPF was higher than that in RA without OPF (38.1％ vs 14.2％,x2=11.708, P=0.001).④ Linear correlation analysis found that serum levels of 25 (OH)D was positively correlated with total lumbar region BMD in RA patients.⑤ Logistic regression analysis revealed that age [OR=1.124, P=0.002, 95％CI: (1.045, 1.209)]and usage of glucocorticostroid (GC) [OR=6.724, P=0.031,95％CI: (1.196, 37.813)] were the risk factors for occurrence of OPF in RA, while serum 25 (OH) D level [OR=0.850, P=0.046, 95％CI: (0.725, 0.997)] was the protective factor.Conclusion Spinal OPF in patients with RA is clearly related with vitamin deficiency, falls and usage of GC.