强直性脊柱炎的骨密度探讨

目的 对与HLA-B27相关的脊椎及关节的免疫性、炎症性病变所伴有的骨质密度与骨矿含量变化进行研究，发现其骨量变化的规律。方法 用双能量骨密度仪(DEXA)测定16例确诊为强直性脊柱炎患者与20例正常对照组病例作比较。结果 早期强直性脊柱炎患者的脊椎及股骨近端骨密度值已有明显降低．晚期病例股骨颈骨密度仍低于对照组．但因晚期病例椎体周围软组织的骨化、矿化．使腰椎骨密度值反而增高。结论 ①强直性脊柱炎本身从早期开始即伴有骨量丢失．在治疗强直性脊柱炎同时应防止骨量丢失及畸形出现。②晚期患者因脊柱周围软组织骨化．使DEXA测量方法不能真实反映椎体骨量丢失，采用QCT方法更为可取。

Investigation of bone mineral density in patients with ankylosing spondylitis

Objective To investigate the relationship between bone mass and an inflammatory and immunological disease of spine and joint associated with positive reaction of HLA|B27. Methods BMD was measured by the dual energy X|ray absorptiometry(DEXA) of 16 patients with definite diagnosis of ankylosing spondylitis, and was compared with that of 20 normal controls. Results The patients in early stage lost the bone mass already,and had lower volume of BMD in both hip and spines than that of controls.But in the later stage the BMD of spines in the patients was higher than that of the control group,even the BMD of femoral neck was still lower than that of normal subjects.Such condition was caused by the calcification and mineralization of the surrounding tissues of the spine in the later stage. Conclusion Ankylosing spondylitis is accompanied with loss of bone mass in its early stage.Prevention of bone loss and deformity is necessary in the same time of treatment.QCT is suitable for measurement of bone mass in later stage,while DEXA cannot reflect the true cause of the calcification and mineralization of the surrounding tissues of the spines in the later stage.