绝经后女性类风湿关节炎患者脊柱骨质疏松性骨折的骨密度阈值探讨

发布时间：2018-03-19 05:19

本文选题：类风湿关节炎　切入点：骨质疏松性骨折　出处：《中国骨质疏松杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的探讨绝经女性中类风湿关节炎(RA)患者发生脊柱骨质疏松性骨折(OPF)的骨密度(BMD)阈值。方法选择334例RA患者及性别、年龄相匹配的健康对照组50例,采用双能X线骨密度吸收仪测定研究对象腰椎2~4(L2、L3、L4、L2-4)的BMD,以X线摄片(脊柱正侧位片)作为确定研究对象骨质疏松性骨折(OPF)的诊断方法。结果 RA腰椎2~4的BMD均明显低于正常对照组(P0.05);RA患者腰椎2~4总的骨质疏松(OP)发生率为27.2%(91/334),明显高于正常对照组OP发生率14.0%(7/50)(!2=4.905,P0.05)。RA患者的腰椎OPF发生率为16.8%(56/334),明显高于对照组6.0%(3/50)(!2=3.877,P0.05)。RA患者OP组中脊柱OPF发生率为39.2%,骨量减少RA患者中脊柱OPF的发生率为15.7%,骨量正常组RA患者中为13.9%,3组间脊柱OPF发生率有明显差别(!2=23.821,P0.001)。RA患者L2-4部位BMD及其对应的T值与发生OPF的ROC曲线分析显示:L2-4BMD-OPF的AUC为0.646,BMD截点值为0.847g/cm2(P0.0001);L2-4T值-OPF的AUC为0.665,T值截点值为-2.25(P0.0001)。RA患者中采用多元Logistic回归分析显示:年龄(OR=1.058,P0.001,95%CI:1.027~1.089)和使用糖皮质激素(OR=2.021,P0.05,95%CI:1.125~3.633)为RA患者发生脊柱OPF的危险因素,腰椎L2-4部位BMD(OR=0.205,P0.05,95%CI:0.048~0.876)为RA患者发生脊柱OPF的保护因素。结论 RA患者发生脊柱OPF的风险明显高于正常人,且在非OP状态下就可以发生,其发生脊柱OPF的腰椎BMD阈值是降低的。
[Abstract]:Objective to investigate the BMD-threshold of bone mineral density (BMD) in postmenopausal women with rheumatoid arthritis (RA) and osteoporosis fracture (OPF). Methods 334 RA patients and 50 age-matched healthy controls were selected. Dual energy X-ray absorptiometry was used to determine the BMDs of lumbar vertebrae (L2L2L3L3OL4L2-4) and X-ray (anteroposterior and lateral position of spine) to determine the diagnostic method of Osteoporosis fracture (Osteoporosis fracture) in the study subjects. Results the BMD of the lumbar vertebrae was significant. Compared with the normal control group, the incidence of OPO was 27.2in the lumbar vertebrae of the patients with RA, which was significantly higher than that in the normal control group (14.0% / 50%, P < 0.05). The incidence of OPO in the patients with RA was 27.2 / 334g, which was significantly higher than that in the normal control group. (2) the incidence of lumbar OPF in patients with RA was 16.80.56 / 334m, which was significantly higher than that in the control group (6.0 / 50 / 50). (2) the incidence of spinal OPF was 39.2 in op group, 15.7 in bone mass reduction group, and 13.9m in normal bone mass group. There was a significant difference in the incidence of spinal OPF among the three groups. 2Analysis of BMD in L2-4 and its corresponding T value in patients with RA and ROC Curve of occurrence of OPF showed that the AUC cut-off point of BMD-OPF was 0.847 g / cm ~ (-2) P _ (0.0001) / L _ (2-4T) -#en4# = 0.665T value -0.665T / T = -2.25g / P 0.0001T / RA. The multivariate Logistic regression analysis showed that the age was 1.058 (P 0.00195CI 1.0271.01089) and sucrose was used. The cortical hormone OR2. 021 (P 0. 05) and CI: 1. 125: 3. 633) were the risk factors for the development of spinal OPF in RA patients. The L2-4 position of lumbar vertebrae BMDO 0.205 P0.0595 95) is the protective factor of spinal OPF in RA patients. Conclusion the risk of developing spinal OPF in RA patients is significantly higher than that in normal persons, and it can occur in non-op state, and the BMD threshold of lumbar spine OPF is decreased.
【作者单位】：安徽医科大学第一附属医院风湿免疫科;
【分类号】：R593.22;R580;R683

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