中国骨质疏松杂志

老年类风湿关节炎合并肌少症患者骨密度及骨代谢指标改变的临床研究

Clinical study on the changes of bone mineral density and bone metabolism indexes in elderly patients with rheumatoid arthritis complicated with sarcopenia

DOI：10.3969/j.issn.1006.7108.2022.03.017

中文关键词: 类风湿关节炎肌少症骨骼肌质量指数疾病活动度骨密度

英文关键词:rheumatoid arthritis sarcopenia skeletal muscle mass index disease activity bone mineral density

基金项目:

作者	单位
何志翔蔡小燕* 林小军叶静华	广州市第一人民医院风湿免疫内科，广东广州 510180

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中文摘要:

目的探讨老年类风湿关节炎(RA)合并肌少症患者骨密度及骨代谢指标改变的状况。方法纳入2017 年1月至 2020 年1月我院治疗年龄均大于等于60岁的165例RA患者以及100例正常体检人员，分别设为研究组与对照组。采用双能X线骨密度仪测定骨密度（BMD）及骨骼肌肉量，计算骨骼肌质量指数( SMI)，比较两组BMD及SMI差异；根据SMI水平将RA患者分为有、无肌少症组，比较两间组骨密度、骨代谢指标及临床资料差异，分析可能影响骨密度的因素。结果 ①RA研究组各部位BMD和SMI水平均低于对照组（P <0.001），RA组发生骨质疏松97例，发生率为58.8 %，是对照组32.0 %的1.83倍（χ2 =17.885，P <0.001）。RA组发生肌少症78例，发生率为47.3 %，是对照组12.0 %的3.94倍（χ2 =34.580，P <0.001）。②RA合并肌少症患者BMI，各部位的BMD和25-(OH)D水平均低于无肌少症组，年龄、病程、血沉，DAS28评分则较高，差异具有统计学意义（P＜0.05）。③RA患者肌少症组骨质疏松发生率为75.6 %，明显高于无肌少症组的43.7 %，差异具有统计学意义（P＜0.001）。④多因素 Logistic 回归分析发现，年龄、病程、DAS28评分是引起RA 伴肌少症患者发生骨质疏松的危险因素(P<0.05), BMI、25-(OH)D为保护性因素(P<0.05)。结论老年RA合并肌少症患者骨质疏松的风险明显升高，受年龄、病程、疾病活动度、BMI、25-(OH)D水平影响。

英文摘要:

Objective To investigate the changes of bone mineral density and bone metabolism indexes in elderly patients with rheumatoid arthritis (RA) complicated with sarcopenia. Methods Retrospective analysis of clinical parameters and bone mineral density was performed in 165 patients with RA and 100 normal cases in control group from January 2017 to June 2020. Bone mineral density (BMD) and skeletal muscle mass were measured using dual-energy X-ray absorptiometry. Skeletal muscle mass index (SMI) was calculated. BMD and SMI were compared between the two groups. RA patients were divided into two groups with and without sarcopenia according to the SMI level. The differences in BND, bone metabolism indexes, and clinical data between the two groups were compared. The independent factors affecting the risk of sarcopenia in RA patients were investigated with logistic regression analysis. Results ①The levels of BMD and SMI in RA group were lower than those in control group (P < 0.001). Osteoporosis occurred in 97 patients in RA group (58.8%), which was 1.83 times more than that in control group (32%, χ2 =17.885, P < 0.001). The incidence of sarcopenia in RA group was 47.3% (78 cases), which was 3.94 times more than that in control group (12%, χ2 =34.580, P < 0.001). ②BMD and 25-(OH)D levels in RA patients with sarcopenia were lower than those in the non-sarcopenia group, while age, course of disease, erythrocytic sedimentation rate, and DAS28 score were higher, and the difference was statistically significant. ③The incidence of osteoporosis in RA patients with sarcopenia group was 75.6%, which was significantly higher than that in the non-sarcopenia group (43.7%). ④Multivariate logistic regression analysis showed that age, course of disease, and DAS28 score were risk factors for osteoporosis in RA patients with sarcopenia (P<0.05), while BMI and 25-(OH)D were protective factors (P<0.05). Conclusion The risk of osteoporosis in elderly RA patients with sarcopenia increases significantly, which is affected by age, disease course, disease activity, BMI, and 25-(OH)D level.

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