类风湿关节炎患者骨密度及骨代谢水平的临床研究

发布时间：2018-10-25 15:39

【摘要】：目的:探讨江西地区类风湿关节炎(RA)患者骨密度(BMD)水平变化、骨代谢情况的临床特征。方法:数据来源于国家风湿病数据中心网络注册系统南昌大学二附属分中心,以2015年4月至2017年2月就诊于我院的RA患者为主。筛选出入组前同时进行了左髋关节及腰椎BMD的测定、关节X线检查、骨代谢指标测定的RA患者。按骨密度测定结果分为骨质疏松、低骨量、骨量正常三组,观察三组在性别、年龄、发病年龄、病程、绝经情况、身体质量指数(BMI)、肿胀关节数(SJC)、压痛关节数(TJC)、有无使用糖皮质激素、血清钙、血清磷、血沉、C反应蛋白、DAS28、DAS44、SDAI、CDAI、X线改变、类风湿因子滴度、抗环胱氨酸肽(CCP)抗体滴度、骨钙素、碱性磷酸酶、甲状旁腺素、25-羟基维生素D等方面变化情况。结果:1、共81例患者符合标准,男性16例(19.8%)、女性65例(80.2%)。骨质疏松35例(43.2%)、低骨量25例(30.9%)、骨量正常21例(25.9%)。OP在腰椎发生率为39.5%,左髋关节为33.3%。2、三组在性别、年龄、发病年龄、绝经情况、血清钙、25-羟基维生素D差异有统计学意义(P0.05);在BMI、病程、肿胀关节数、压痛关节数、有无使用糖皮质激素、ESR、CRP、血P、RF滴度、抗CCP抗体滴度、DAS28、DAS44、SDAI、CDAI、骨钙素、碱性磷酸酶、甲状旁腺素等方面差异无统计学意义(P0.05)。3、三组局部骨损害发生率逐渐减低,以OP组最高,但无统计学差异。结论:RA合并OP与性别、发病年龄、是否绝经、25-羟基维生素D缺乏相关。对RA患者,尤其是高龄或绝经女性患者应常规进行骨密度的筛查,早期即补充维生素D3和钙剂。
[Abstract]:Objective: to investigate the changes of bone mineral density (BMD) and bone metabolism in patients with rheumatoid arthritis (RA) in Jiangxi province. Methods: the data were obtained from the second affiliated sub-center of Nanchang University, the network registration system of National Rheumatological data Center. The main data were RA patients in our hospital from April 2015 to February 2017. BMD of left hip and lumbar vertebrae, X-ray examination of joint and bone metabolism were measured in RA patients before screening. According to the results of bone mineral density measurement, the patients were divided into three groups: osteoporosis, low bone mass and normal bone mass. The sex, age, onset age, course of disease, menopause were observed in the three groups. Body mass index (BMI),) swelling joint number (SJC), tenderness joint number (TJC), whether use glucocorticoid, serum calcium, serum phosphorus, erythrocyte sedimentation rate, C-reactive protein, DAS28,DAS44,SDAI,CDAI,X line change, rheumatoid factor titer, anti-cysteine peptide (CCP) antibody titer, osteocalcin, Alkaline phosphatase, parathyroid hormone, 25-hydroxyvitamin D and so on. Results: 1. There were 81 patients, 16 males (19.8%) and 65 females (80.2%). There were 35 cases of osteoporosis (43.2%), 25 cases of low bone mass (30.9%), 21 cases of normal bone mass (25.9%). OP), 39.5% of lumbar vertebrae and 33.33.2% of left hip joint. There were significant differences in sex, age, age of onset, menopause, serum calcium and 25-hydroxyl vitamin D in the three groups (P0.05); The number of swollen joints, the number of tenderness joints, whether glucocorticoid was used, the titer of ESR,CRP, blood, the titer of anti CCP antibody, DAS28,DAS44,SDAI,CDAI, osteocalcin, alkaline phosphatase, parathyroid hormone and so on were not significantly different (P0.05). OP group was the highest, but there was no statistical difference. Conclusion: RA combined with OP is associated with sex, age of onset, menopause and 25-hydroxyvitamin D deficiency. BMD screening should be performed regularly in RA patients, especially in elderly or menopausal women, and vitamin D 3 and calcium should be supplemented at the early stage.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.22

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