摘要
目的分析未绝经女性早期RA患者伴发骨质疏松症的情况及探讨相关临床危险因素。方法收集76例住院的未绝经女性早期RA患者和84名未绝经女性健康对照组，采用双能X线骨密度测定仪（DEX）测定股骨颈、Ward区、大转子和腰椎1-4部位骨密度，采用ELISA法检测骨代谢指标[Ⅰ型胶原交联C-末端肽（CTX）、Ⅰ型原胶原N-端前肽（PINP）]和免疫炎症因子（IL-17、IL-6、TNF-α）。定量分析采用非参数检验（Z值）或方差分析；定性分析采用Fisher确切概率法或Logistic回归分析研究相关的风险因素。结果①未绝经女性早期RA患者的股骨颈（0.802±0.193）g/cm2、股骨大转子区（0.923±0.033）g/cm2、腰椎1部位（0.862±0.011）g/cm2的骨密度显著低于对照组[（0.981±0.032）g/cm2、（0.771±0.023）g/cm2、（0.912±0.012）g/cm2；F值分别为14.401、19.860、6.560，P均〈0.05]，未绝经女性早期RA的骨质疏松发生率为7%（5/76），显著高于对照组1%（1/84）。②未绝经女性早期RA患者的骨代谢指标[（CTX：（0.37±0.21）ng/ml]和免疫炎症因子[（TNF-α：（9.8±4.1）pg/ml；IL-6：（33.6±5.7）pg/ml；IL-17：（129±24）pg/ml]水平较对照组[（0.24±0.09）ng/ml、（6.7±1.9）pg/ml、（1.5±0.4）pg/ml、（45±7）pg/ml]显著升高（Z值分别为2.722、5.932、7.501、4.370，P均〈0.05）。③未绝经女性早期RA患者中，骨质疏松组其在BMI（9±3）kg/ml2、骨密度部分指标股骨颈（0.85±0.20）g/cm2、腰椎2（0.75±0.23）g/cm2、腰椎3（0.87±0.07）g/cm2、腰椎4（0.92±0.12）g/cm2以及ESR [47.8（22.0，76.0）mm/1 h]、DAS28-CRP（5.3±1.2）与正常组比，差异均有统计学意义[（16±3）kg/m2、（0.88±0.14）g/cm2、（0.82±0.14）g/cm2、（0.93±0.14）g/cm2、（0.94±0.16）g/cm2、18.8（8.7，35.2）mm/1 h、3.8±1.2，F值分别为0.68、14.632、26.114、20.931、36.582，Z值分别为3.21、6.58，P均〈0.05]。④ Logistic回归分析提示在未绝经女性早期RA患者中，IL-6（Wald χ2=5.78、P=0.021）、PINP（Wald χ2=5.12、P=0.031）、CTX（Wald χ2=9.17、P=0.003）、ESR（Wald χ2=9.24、P=0.011）、DAS28-CRP（Wald χ2=17.28、P=0.001）是骨质疏松发生的高危因素，将上述有统计学意义的变量（IL-6、PINP、CTX、ESR、DSA28）变量纳入非条件有序Logistic回归分析中，结果显示DAS28-CRP评分[OR=1.58，95%CI（1.10，2.20）]是发生骨质疏松的重要危险因素。
结论未绝经女性早期RA患者骨质疏松发生率高，临床需重视与预防。DAS28-CRP评分是早期RA患者发生骨质疏松的危险因素，改善未绝经女性早期RA患者病情有助于预防其骨质疏松的发生与发展。
ObjectiveTo identify the clinical features and risk factors of early rheumatoid arthritis （RA）-associated osteoporosis in premenopausal women.MethodsA total of 76 premenopausal women with early RA were randomly selected in the Department of Kidney and Rheumatology in the hospital. A total of 84 health cases were randomly selected in our hospital as controls. Bone mineral density （BMD） was determined using dual energy X-ray absorptiometry （DEX）. Bone metabolism （CTX, PINP） and inflammatory cytokines （IL-17, IL-6, TNF-α） were examined with quantitative enzyme-linked immune-sorbent assay （ELISA）.Quantitative data were expressed as ±s deviation and the data were compared between groups using non-parametric test （Z value）. Multi-group comparison was performed with variance analysis. Qualitative data were compared with Fisher＇s test. Logistic regression was used to investigate the risk factors.Results① Compared with the control group, BMD in the premenopausal women with early RA group [neck： （0.802±0.193） g/cm2, GT zone： （0.923±0.033） g/cm2, L1： （0.862±0.011） g/cm2] was significantly decreased [（0.981±0.032） g/cm2, （0.771±0.023） g/cm2, （0.912±0.012） g/cm2, F=14.401, 19.860, 6.560, respectively, both P〈0.05）. The prevalence of osteoporosis in this group was 7%（5/76）, which was higher than controls 1%（1/84）. ② According to values of Bone meta-bolism [（CTX： （0.37±0.21） ng/ml] and inflammatory cytokines, TNF-α： （9.8±4.1） pg/ml, IL-6： （33.6±5.7） pg/ml and IL-17： （129±24） pg/ml were markedly increased in premenopausal women in early RA group [（0.24±0.09） ng/ml, （6.7±1.9） pg/ml, （1.5±0.4） pg/ml, （45±7） pg/ml, Z=2.722, 5.932, 7.501, 4.370, respectively, both P〈0.05]. ③ The premenopausal women with early RA group with osteoporosis were signifi-cantly difference with controls in BMI [（9±3） kg/m2vs （16±3） kg/m2], bone density of neck [（0.85±0.20） ng/ml vs （0.88±0.14） g/cm2], L2 [（0.75±0.23） g/cm2vs （0.88±0.14） g/cm2], L3 [（0.87±0.07） g/cm2vs （0.93±0.14） g/cm2], L4 [（0.92±0.12） g/cm2vs （0.94±0.16） g/cm2], serum ESR [47.8（22.0, 76.0） mm/1 h vs 18.8（8.7, 35.2） mm/1 h] and DAS28-CRP （5.3±1.2 vs 3.8±1.2） F=0.68, 14.632, 26.114, 20.931, 36.582, Z=3.21, 6.58, respectively, both P〈0.05. ④ Logistic regression showed that IL-6 （Wald χ2=5.78, P=0.021） , PINP （Wald χ2=5.12, P=0.031）, CTX （Wald χ2=9.17, P=0.003）, ESR （Wald χ2=9.24, P=0.011）, DAS28-CRP （Wald χ2=17.28, P=0.001） were significantly positively correlated with osteoporosis. Moreover, ordered unconditional Logistic regression analysis of the variables （IL-6, PINP, CTX, ESR, DSA28） described above showed that DAS 28-CRP score [OR=1.58, 95% CI： （1.10, 2.20）] was the most important risk factor for osteoporosis in premenopausal women with early RA.ConclusionThe incidence of osteoporosis is high in premenopausal women with early RA than healthy cases. DAS 28-CRP score is the important risk factor for premenopausal women with early RA-associated osteoporosis. Measures relieve symptoms of RA can help to prevent and treatment osteoporosis.
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2016年第3期169-175,共7页
Chinese Journal of Rheumatology
关键词
关节炎
类风湿
未绝经女性
骨质疏松
骨密度
早期
Arthritis, rheumatiod
Premenopausal women
Osteoporosis
Bone Mineral Density
Early
