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| 绝经后女性类风湿关节炎患者脊柱骨质疏松性骨折的骨密度阈值探讨 |
| Exploration of bone mineral density threshold for spinal osteoporotic fractures in postmenopausal female patients with rheumatoid arthritis |
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| DOI：10.3969/j.issn.1006.7108.2017.02.007 |
| 中文关键词: 类风湿关节炎 骨质疏松性骨折 骨密度 阈值 |
| 英文关键词:Rheumatoid arthritis Osteoporotic fractures Bone mineral density Threshold |
| 基金项目: |
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| 中文摘要: |
| 目的 探讨绝经女性中类风湿关节炎（RA)患者发生脊柱骨质疏松性骨折（OPF)的骨密度（BMD)阈值。方法 选择334例RA患者及性别、年龄相匹配的健康对照组50例，采用双能父线骨密度吸收仪测定研究对象腰椎2~4(L2、L3、L4、L2-4) 的BMD，以X线摄片（脊柱正侧位片）作为确定研究对象骨质疏松性骨折（OPF)的诊断方法。结果 RA腰椎2 ~4的BMD均明显低于正常对照组（P <0.05); RA患者腰椎2 ~4总的骨质疏松（OP)发生率为27. 2% (91/334),明显高于正常对照组OP 发生率 14.0% (7/50) (χ2 =4. 905,P<0. 05) 0 RA 患者的腰椎OPF 发生率为 16. 8% (56/334)，明显高于对照组 6.0% (3/50) (χ2 = 3. 877，P<0.05)。RA患者OP组中脊柱OPF发生率为39. 2%，骨量减少RA患者中脊柱OPF的发生率为15.7%，骨量正常组RA患者中为13. 9% ,3组间脊柱OPF发生率有明显差别（χ2=23. 821，P <0. 001)。RA患者L2-4部位BMD及其对应的 T值与发生OPF 的 ROC 曲线分析显示:L2-4 BMD-OPF 的 AUC 为 0. 646，BMD 截点值为 0. 847g/cm2 (P <0. 0001 )；L2-4 T 值-OPF 的AUC为0.665,T值截点值为-2. 25 (P <0.0001 )。RA患者中采用多元Logistic回归分析显示：年龄（OR = 1.058, P < 0. 001,95% CI: 1. 027 ~ 1. 089)和使用糖皮质激素(OR=2. 021 ,P <0. 05 ,95% CI: 1. 125 ~ 3. 633)为 RA 患者发生脊柱 OPF 的危险因素，腰椎部位L2-4(OR=0.205,P<0.05，95%CI:0.048 ~0.876)为RA患者发生脊柱OPF的保护因素。结论 RA 患者发生脊柱OPF的风险明显高于正常人,且在非OP状态下就可以发生，其发生脊柱OPF的腰椎BMD阈值是降低的。 |
| 英文摘要: |
| Objective To explore the bone mineral density (BMD) threshold for spinal osteoporotic fractures (OPF) in postmenopausal female patients with rheumatoid arthritis (RA). Methods Three hundred and thirty-four patients with RA were enrolled in the study. Fifty normal subjects were recruited as control group. BMD at the lumbar vertebra 2-4 (L2，L3, L4，L2-4) was measured with dual energy X-ray absorptiometry in all subjects. X-rays examination (vertebral column) was used for the diagnosis of OPF. Results BMD of the lumbar vertebra 2-4 in RA was significantly lower than that in control group (P < 0. 0001). The prevalence of osteoporosis (OP) at lumbar vertebra in RA (27. 2% ) was significantly higher than that in control group (14, 0% , χ2 =4. 905, P < 0. 05). The prevalence of OPF of lumbar vertebrae in patients with RA (16. 8% ) was significantly higher than that in control group (6% ). The prevalence of spinal OPF was 39. 2% in RA with OP, while it was 15.1% in RA with OP, and 13. 9% in RA with normal bone mass. The difference was signiHcant among the three groups (χ2 = 23. 821 ,P < 0, 001 ). Analyses of receiver operator characteristic (ROC) curve in RA patients with vertebral OPF showed that BMD of L2-4-OPF AUC was 0. 646, and the cut-off value of BMD was 0. 847 g/cm2 (P < 0.0001). The T value of L2-4 BMD-OPF AUC was 0. 665, and the cut-off value of T value was - 2. 25 (P < 0. 0001) . Logistic regression analysis revealed that age ( OR = 1. 058，P< 0. 001, 95% CI：1. 027 - 1. 089) and use of glucocorticoids ( OR = 2. 021, P < 0. 05，95% CI: 1. 125 - 3. 633 ) were the risk factors for the development of spinal OPF in RA. BMD at L2-4(OR = 0. 205, P < 0. 05, 95% CI：0. 048 - 0. 876) was the protective factor. Conclusion The risk of spinal OPF in patients with RA is much higher than that in normal subjects. It is noticeable that vertebral OPF can even happen in RA patients without OP, and its threshold of BMD for spinal OPF is reduced. |
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