绝经后女性类风湿关节炎患者骨密度变化影响因素分析

目的探讨绝经后女性类风湿关节炎(RA)患者发生骨质疏松(OP)的原因。方法收集63例绝经后女性RA患者一般临床资料、疾病活动相关指标、手足X线资料,并同时测量患者7个部位的骨密度。结果23例患者(36.5%)有至少一处检测部位表现为低骨量。前臂和桡尺骨远端的低骨密度发生率(23.8%)与OP总发生率(28.6%)无显著性差异(P>0.05)。OP的发生与疾病活动指标及糖皮质激素的使用均无相关性。多元回归分析显示绝经的年限和关节腔狭窄为低骨量发生的独立危险因素(P<0.05);而雌激素替代疗法(HRT)为低骨量发生的唯一保护因素(P<0.05),小剂量糖皮质激素对本组患者的骨密度无影响。结论OP是绝经后女性RA患者的常见并发症,绝经年限长和关节破坏严重是低骨量发生的独立危险因素,HRT是防治低骨量的保护因素。

Factors associated with bone loss in postmenopausal women with rheumatoid arthritis

Objective:To evaluate disease related determinants of bone mineral density(BMD)in postmenopausal patients with rheumatoid arthritis(RA).Methods:Sixty-three postmenopausal RA patients demographic,clinical and BMD data were collected.Associations between demographic and clinical variables on the one hand and osteoporosis(OP)on the other were investigated in multiple regression analyses.Results:36.5% of patients had bone loss in at least one site.There were no relationships between bone loss and disease activity and also corticosteroid use.Logistic regressions showed that duration of menopause and X ray joint space narrowing(JSN) were the risk factors of bone loss(OR:1.298,95%CI:1.014-1.530,P=0.046 and OR:1.434,95%CI:1.057-1.946,P=0.020,respectively),and hormone replacement treatment(HRT) was the only protective factor of bone loss (OR:0.232,95%CI:0.057-0.952,P=0.032).Conclusion:OP is a common manifestation in postmenopausal RA patients.Long years of menopause and joint destruction are main risk factors of bone loss,and HRT can protect bone loss in the patients.