绝经后活动性类风湿性关节炎患者低骨密度的相关危险因素分析

目的分析绝经后活动性类风湿性关节炎(rheumatoid arthritis,RA)患者出现低骨密度相关的危险因素。方法研究对象为106例患有活动性RA的绝经后妇女,患者按体质量指数(BMI)分组:I组消瘦(18.5～24.9 kg/m~2,n=36),II组超重(25.0～29.9 kg/m~2,n=35),III组肥胖(30.0 kg/m~2,n=35)。检测这些患者的股骨BMD和血清BTM水平:骨钙素(OC)和I型胶原交联C-端肽片段(CTX)和骨桥蛋白(OPN)、抵抗素、高敏C反应蛋白、白细胞介素-6、肿瘤坏死因子(TNF)-a。结果与较瘦的女性相比,肥胖女性的总股骨BMD和总T评分显然更高(P0.05);发现BMD和CTX水平与体重存在显著相关性(P0.05)。调整股骨颈BMD后,BMI与TNF-α水平呈负相关(P0.05)。骨钙素水平与抵抗素呈负相关(P0.05),CTX水平与OPN呈正相关(P0.05);并发现BTM和BMD与其他炎症指标之间的关联。观察到OPN水平与体重、腰围和绝经后时间之间呈负相关性(P0.05)。结论本研究结果表明,体重和OPN、抵抗素和TNF-α在绝经后活动性RA患者的骨密度降低中起重要作用。

Analysis of risk factors associated with low bone mineral density in postmenopausal women with active rheumatoid arthritis

Objective To analyze the risk factors associated with low bone mineral density in postmenopausal patients with active rheumatoid arthritis (RA). Methods A total of 106 postmenopausal women with active RA were studied. Patients were grouped by body mass index (BMI): group I was lean (18.5-24.9 kg/m2,n=36), group II was overweight (25.0-29.9 kg/m2, n=35), group III was obese (>30.0 kg/m2, n=35). The femoral BMD and serum levels of BTMs: osteocalcin (OC), collagen type I cross-linked C-telopeptide fragments (CTX), osteopontin (OPN), resistin, high sensitivity C-reactive protein, interleukin-6, and tumor necrosis factor-a (TNF-a)were measured in these patients. Results Femoral BMD and total T-score were significantly higher in obese women than in lean subjects (P<0.05). BMD and CTX levels were significantly associated with body mass parameters (P<0.05, respectively). After adjusting femoral neck BMD, BMI was negatively associated with the TNF-a levels (P<0.05). Osteocalcin level was negatively correlated with resistin (P<0.05). CTX level was positively correlated with OPN (P<0.05). There were associations between BTM and BMD and other inflammatory indices. OPN was negatively correlated with body weight (P<0.05), waist circumference(P<0.05), and duration of postmenopausal period (P<0.05). Conclusion The present study suggests that body weight, OPN, resistin, and TNF-a play an important role in lowering BMD in postmenopausal women with active RA.