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| 肝肾阴虚型类风湿关节炎与骨质疏松相关性研究 |
| Correlation of yin deficiency in liver and kidney type of rheumatoid arthritis and osteoporosis |
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| DOI：10.3969/j.issn.1006.7108.2017.02.015 |
| 中文关键词: 关节炎；类风湿 骨代谢；骨质疏松 肝肾阴虚 |
| 英文关键词:Arthritis Rheumatoid Bone metabolism Osteoporosis Yin deficiency in liver and kidney |
| 基金项目:国家自然科学基金资助项目（81272537，30801497);江苏省高校自然科学基金资助项目（11KJB360010);扬州大学新世纪创新人才项目资助 |
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| 中文摘要: |
| 目的 探究肝肾阴虚型类风湿关节炎患者骨质疏松的发生情况，从相关实验室指标分析其相关性并预测继发性骨质疏松的危险因素及发生情况。方法 选取符合标准的肝肾阴虚型类风湿关节炎的病人。进行常规血细胞分析、血沉（ESR)、 C-反应蛋白（CRP)、类风湿因子（IgARF IgMRF，IgGRF)、抗环瓜氨酸肽抗体（抗CCP抗体）检测、骨代谢指标检查和骨密度 (BMD)检查。使用多种统计学方法分析其相关性并预测危险因素。结果 共选取符合标准的肝肾阴虚型RA患者64人。其中骨质疏松患者共30人，占46. 88%。明显较湿热痹阻型RA发生率（18. 18% )高。BMD与抗CCP抗体数值相关，骨质疏松的患者抗CCP抗体较高；血红蛋白数值与BMD有关，骨量正常组的血红蛋白数值较高。急性炎症指标与PTH水平呈显著负相关关系，IgMRF、抗CCP抗体、PTH水平与髋部BMD水平呈现明显的负相关关系。年龄大于65岁患者较其他患者髋部骨质疏松的风险多约一倍;血沉异常患者的腰椎及髋部骨质疏松的发生率均为血沉正常患者的10倍左右；抗CCP抗体高滴度患者腰椎骨质疏松的发生率为其他患者的7倍、髋部骨质疏松的发生率为其他患者的9倍余。结论 年龄、ESR、抗CCP抗体水平与BMD值关系密切，均为继发骨质疏松的危险因素，其中年龄大于65岁，ESR、抗CCP抗体水平较高、血红蛋白水平较低的RA肝肾阴虚型患者，即RA控制不佳的肝肾阴虚型患者更易患继发性骨质疏松。 |
| 英文摘要: |
| Objective To explore the incidence of osteoporosis in patients with yin deficiency in liver and kidney type of rheumatoid arthritis, and to study risk factors for secondary osteoporosis through analyzing the correlations of laboratory indexes. Method Patients conformed the diagnostic standards were selected and received relevant examinations. Analyses performed include one-way analysis of variance, LSD, Spearman correlation analysis, likelihood ratio test, and multivariate logistic regression to study the risk factors and occurrence. Result Among the 64 patients with yin deficiency in liver and kidney type of rheumatoid arthritis, 30 (46. 88% ) had osteoporosis, which is significantly higher than the incidence in the damp heat syndrome type of RA (18. 18% ). BMD was related to anti-CCP antibody and HB was linked to secondary osteoporosis. Acute inflammatory markers had negative correlation with PTH, and IgMRF, anti-CCP antibody, and PTH levels had significant negative correlations with hip BMD. The risk for secondary osteoporosis in patients older than 65 years were twice of that in patients younger than 65. The incidence of lumbar spine osteoporosis in patients with high anti-CCP antibody was 7 times higher than other patients while the hip osteoporosis was 9 times higher. The risk of having osteoporosis at hip or spine are 10 times higher in patients with abnormal ESR than those with normal ESR. Conclusion Age, ESR, anti-CCP antibody are secondary osteoporosis risk factors and can predict occurrence. Yin deficiency in liver and kidney type of RA patients who are older than 65 years，have high ESR and anti-CCP antibody level and low HB level are more likely to have secondary osteoporosis. |
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