中国骨质疏松杂志

体质指数和体脂百分比与类风湿关节炎继发骨质疏松的相关性研究

Association of body mass index, percentage of body fat, and secondary osteoporosis of rheumatoid arthritis

DOI：10.3969/j.issn.1006.7108.2018.09.009

英文关键词:rheumatoid arthritis BMI PBF bone mineral density

基金项目:

作者	单位
徐月辰徐胜前*何秋时陈俊杰陈圆圆李健	安徽医科大学第一附属医院风湿免疫科，安徽合肥 230022

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中文摘要:

目的探讨体质指数（BMI）和体脂百分比（PBF）与类风湿关节炎（RA）继发骨质疏松（OP）间的相关性。方法采用生物电阻抗体成分测定法测量359例RA患者和158例年龄、性别相匹配的正常对照组体重（kg）、身高（m）和PBF，根据体重/（身高）2计算出BMI，并将BMI分为4组：消瘦BMI<18.5，正常24>BMI≥18.5，超重28>BMI≥24，肥胖BMI≥28；PBF分为2组：肥胖为PBF男>25%或女>30%，否则为正常。采用双能X线骨密度吸收仪测定髋部（包括股骨颈Neck、Ward三角区、大转子GT、总髋部Hip）及腰椎1-4（L1-4）骨密度（BMD）。结果 RA患者BMI低于正常对照组（22.40±3.76 vs 23.66±3.24，t=3.813，P<0.0001），其中消瘦患者百分比明显高于对照组（14.4% vs 5.8%，x2=10.536，P=0.015）；而PBF则高于对照组（32.45±10.38 vs 30.53±6.98，t=2.442，P=0.015）。RA患者OP发生率为37.9%（128/338），明显高于对照组的13.9%（22/158）（x2=29.265，P＜0.0001）。RA患者不同BMI分组间各部位BMD均有显著不同，且都表现为消瘦组水平更低，超重或肥胖组水平更高（P＜0.0001~0.05）；除Ward区的PBF正常组BMD高于肥胖组（t=2.224，P=0.027）外，其余各部位BMD均无明显差别（P＞0.05）。Hip区和L1-4区均表现为消瘦组OP发生率（27.8%、20.7%）明显高于肥胖组（3.7%、1.1%）（x2=22.041，P=0.001；x2=13.401，P=0.037）。不同PBF分组间骨量构成比的比较无差别（P＞0.05）。各部位BMD均与BMI成正直线相关（P＜0.0001~0.01）；而Ward、GT、Hip区BMD与PBF成负直线相关（P=0.015~0.04）。多元Logistic回归分析结果显示：年龄（OR=1.114，95%CI：1.082～1.148，P＜0.0001）、性别（OR=5.802，95%CI：2.608～12.906，P＜0.0001）和病程（OR=1.050，95%CI：1.017～1.084，P=0.003）均为RA患者发生OP的危险因素，而BMI（OR=0.879，95%CI：0.815～0.946，P=0.001）为发生OP的保护因素。结论 BMI和PBF在RA中变化不同，且呈现出与BMD相反的相关性，BMI是RA患者发生OP的保护因素。

英文摘要:

Objective To explore relationships among body mineral index (BMI), percentage of body fat (PBF), and rheumatoid arthritis (RA) induced osteoporosis (OP). Methods Three hundred and fifty-nine patients with RA and 158 age and gender-matched normal controls were recruited. Weight, height, and PBF were measured. BMI was calculated according to weight(kg)/height(m)2. Four groups were divided according to BMI, weight loss (BMI<18.5), normal (24>BMI≥18.5), overweight (28>BMI≥24), and obesity (BMI≥28). According to PBF, obesity was defined in males (PBF>25%) or female (PBF>30%), others were defined as normal. Bone mineral density (BMD) of the proximal femur (neck, Ward, GT, Hip) and the lumbar vertebrae (L1-4) was measured using dual energy X-ray absorptiometry (DEXA). Results Average BMI in RA was lower than that in controls (22.40±3.76 vs 23.66±3.24, t=3.813, P<0.0001). Percentage of weight loss in RA was obviously higher than that in normal (14.4% vs 5.8%, x2=10.536, P=0.015). However, average of PBF in RA was clearly higher than that in controls (32.45±10.38 vs 30.53±6.98, t=2.442, P=0.015). Incidence of OP in RA was higher than that in control (40.7%, 134/330 vs 13.9%, 22/158, x2=35.227, P<0.0001). BMD at each site in RA with weight loss was the lowest, and BMD in RA with overweight or obesity was highest (P<0.0001-0.05). BMD at Ward site in RA with normal PBF was higher than that in PBF group with obesity (t=2.224, P=0.027). It was similar among other RA groups (P>0.05). Incidence of OP at the site of Hip and L1-4 in RA with weight loss (27.8%, 20.7%) was higher than that in groups with obesity (3.7%, 1.1%, x2=22.041, P=0.001; x2=13.401, P=0.037). There was no significant difference about percentage of bone mass between groups with different PBF (P>0.05). There were positive linear correlations between BMD at each site and BMI (P<0.0001-0.01). BMD at sites of Ward, GT, and Hip was negatively correlated with PBF (P=0.015-0.04). Logistic regression analysis discovered that age (OR=1.114, P<0.0001, 95%CI:1.082~1.148), sex (OR=5.802, P<0.0001, 95%CI:2.608~12.906), and disease duration (OR=1.050, P=0.003, 95%CI:1.017-1.084) were risk factors for OP in RA, while BMI (OR=0.879, P=0.001, 95%CI:0.815-0.946) was the protective factor for the occurrence of OP in RA. Conclusion BMI and PBF change differently in RA, which represent different correlations with BMD. BMI is the protective factor for the occurrence of OP in RA.

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