类风湿关节炎患者骨密度及骨矿物质含量的变化及意义

目的探讨类风湿关节炎(RA)患者骨密度(BMD)及骨矿物质(BMC)含量的变化及意义。方法选择71例RA患者(RA组)及20例正常人(对照组),采用双能X线骨密度仪检测各组前臂BMD、BMC含量,魏氏法检测血沉(ESR),免疫比浊法检测血清C反应蛋白(CRP),速率散射比浊法检测类风湿因子(RF),ELISA法检测抗环瓜氨酸肽抗体(ACCP);同时进行X线分期,计算患者疾病活动分数(DAS28)。结果 RA组前臂BMD、BMC均低于对照组(P均<0.01),ESR、CRP、RF、ACCP均高于对照组(P均<0.01)。Pearson’s相关分析显示,前臂BMD与DAS28、ESR、RF呈负相关(r分别为-0.357、-0.390、-0.255,P<0.05或<0.01),前臂BMC与DAS28、ESR呈负相关(r分别为-0.344、-0.401,P均<0.01)。多元线性回归分析显示,前臂BMD与RF、年龄呈负相关(T分别为-7.544、-3.254,P均<0.01);前臂BMC与DAS28呈负相关(T=-4.44,P<0.01)。RA组中X线分期为Ⅰ期的有15例,其中BMD示骨质疏松6例、骨量减少2例。结论 RA患者BMD、BMC含量明显减少,其含量减少与RA活动密切相关;RF可能是导致RA骨量丢失的危险因素;BMD检测能更早反映RA患者的骨量丢失情况。

Changes of bone mineral density and bone mineral conten in patients with rheumatoid arthritis and its significance

Objective To investigate the changes and clinical significance between bone mineral density(BMD) and bone mineral conten(BMC) in patients with rheumatoid arthritis(RA).Methods The BMD and BMC of patients of RA and normal control group were measured by means of dual energy X-ray absorptiometry in the forearm.The correlations of indexes were analyzed by linear correlation analysis and multiple linear regression analysis.Results The BMD and the BMC of patients with RA were significant deceased compared to normal control group(P<0.05).The BMD in forearm was negatively correlated with DAS28 score,ESR and RF(r=-0.357,-0.390,-0.255,P<0.05),respectively.There was a significant negative correlation between BMC in forearm and DAS28 score,ESR(r=-0.344,-0.401,P<0.05).And multiple linear regression analysis showed that the BMD in forearm with RF and age were negatively correlated;The BMC in forearm was negatively correlated with the DAS score.The patients of RA with X-ray for the period I have 15 cases,which 6 patients showed osteoporosis,bone mass decreased by 2 cases,bone loss and osteoporosis in patients with a total of 8 cases.Conclusions The declines of BMD and BMC of patients with RA are more obvious;BMD and BMC loss may be closely related with disease activity;The BMD may be reflected the loss of bone mass in patients with RA more reflected earlier than X-ray.