少肌症、维生素D缺乏在类风湿性关节炎合并脊柱骨质疏松性骨折中的临床研究

发布时间：2018-07-10 08:36

本文选题：类风湿关节炎 + 骨质疏松性骨折　；参考：《中国骨质疏松杂志》2017年02期

【摘要】：目的探讨少肌症和维生素D缺乏在RA患者脊柱骨质疏松性骨折(OPF)中的临床意义。方法入选936例RA患者和158例年龄、性别相匹配的正常健康者,所有入选对象均摄脊柱正侧位X线片(T5-L5),并以半定量(SQ)法作为判断脊柱OPF的标准,其中648例RA患者和对照组采用DXA法测定了腰椎和髋部骨密度(BMD),267例RA患者和156例对照组以生物电阻抗法测定了四肢骨骼肌质量,化学发光法测定了234例RA患者和68例对照组血清25(OH)D水平,同时详细记录RA患者各临床及实验室指标等情况。结果 1RA患者中(141/936,15.1%)OPF的发生率明显高于对照组(6/158,3.8%)(χ2=18.658,P0.0001);少肌症的发生率明显高于对照组(55.8%,149/267 vs 9.0%,14/156,χ2=91.176,P0.0001);RA组血清25(OH)D水平明显低于对照组[(13.41±9.71)ng/m L,(22.40±6.26)ng/m L,t=9.063,P0.0001],维生素D缺乏发生率明显高于对照组[80.8%(189/234)vs 36.8%(25/68),χ2=49.412,P0.0001]。2RA患者OPF组25(OH)D水平明显低于无OPF组[(12.28±5.67)ng/m L vs(17.16±10.90)ng/m L,t=2.600,P=0.01];各部位肌肉量均明显低于无OPF组(P0.01~0.05)。3线性相关分析发现:RA患者的25(OH)D与骨骼肌、右上肢、左上肢和躯干肌肉量呈正直线相关关系(P0.05);RA患者的骨骼肌质量与髋部、腰椎各部位BMD呈正直线相关关系(P0.05)。4多元回归分析显示:女性、HAQ积分和总氈部OP的发生为RA患者发生少肌症的危险因素;年龄为RA患者发生脊柱OPF的危险因素,骨骼肌质量指数(SMI)为RA患者发生脊柱OPF的保护因素。结论 RA患者具有高于正常健康者脊柱OPF的发生率,其25(OH)D水平缺乏普遍存在,少肌症发生率增高;RA患者维生素D缺乏、少肌症与RA患者脊柱OPF的发生密切相关。
[Abstract]:Objective to investigate the clinical significance of oligomyopathy and vitamin D deficiency in osteoporotic fracture of spine (OPF) in RA patients. Methods 936 patients with RA and 158 healthy subjects with matched age and sex were enrolled. All subjects were enrolled in the study. All the subjects were examined by axial and lateral radiography (T5-L5), and semi-quantitative (sq) method was used as the criterion for judging the OPF of the spine. Bone mass of extremities was measured by bioelectric impedance method in 648 RA patients and control group by DXA method in 267 RA patients with lumbar spine and hip bone mineral density (BMD) and 156 controls. The serum levels of 25 (OH) D in 234 RA patients and 68 controls were measured by chemiluminescence method. The clinical and laboratory indexes of RA patients were recorded in detail. Results 1the incidence of OPF in RA patients (141 / 936 / 15.1%) was significantly higher than that in the control group (6 / 1588 / 3.8%) (蠂 ~ 2 / 18.658 / P 0.0001), and the incidence of oligomyopathy was significantly higher than that in the control group (55.8i / 149p / 267 vs 9.0 / 14 / 156, 蠂 ~ 291.176g / P 0.0001). The level of serum 25 (OH) D in RA group was significantly lower than that in the control group [(13.41 卤9.71) ng/m L, (22.40 卤6.26) ng/m L ~ (9.063P) 0.0001], and the incidence of vitamin D deficiency was significantly higher than that in the control group [(80.8%) (1899 / 234) vs (189234) vs. 36.8% (25 / 68), 蠂 ~ (2 +) 49.412g / P 0.0001] .The level of 25 (OH) D in patients with RA was significantly lower than that in patients without OPF [(12.28 卤5.67) ng/m / L vs (17.16 卤10.90) ng/m / L ~ 2.600 / P ~ (0.01)]. The muscle mass of right upper limb, left upper limb and trunk were positively correlated (P0.05). The linear correlation of BMD in all parts of lumbar vertebrae was positive (P0.05). 4 multiple regression analysis showed that the incidence of HAQ score and op in general felt was the risk factor of oligomyopathy in RA patients, and age was the risk factor of OPF in RA patients. Skeletal muscle mass index (SMI) was the protective factor of OPF in RA patients. Conclusion the incidence of OPF in RA patients is higher than that in normal controls, and the level of 25 (OH) D is generally absent. The incidence of oligomuscular disease is higher than that of vitamin D deficiency in RA patients. Oligomyopathy is closely related to the occurrence of OPF in RA patients.
【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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