来源：风湿病与关节炎,2022,11（3）:8-12.

类风湿关节炎患者骨量异常临床相关因素分析（临床研究）

陈水绵，郑辉福，许超尘，饶华春，吴振斌

　　【摘　要】目的：探讨类风湿关节炎患者骨量异常临床相关因素的特点。方法：选取119例确诊为类风湿关节炎的患者，采用双能X线吸收法测定骨密度，根据患者骨密度分为骨质疏松组55例，骨量减少组38例与骨量正常组26例，纳入患者年龄、病程、绝经与否、C反应蛋白（CRP）、类风湿因子（RF）、红细胞沉降率（ESR）、25羟维生素D3［25-（OH）D3］、总I型胶原氨基端前肽（TPINP）、β胶原特殊序列（β-CTX）及骨密度（BMD）等十项指标，分析比较3组间各指标水平差异，多因素logistic回归分析上述指标与类风湿关节炎患者骨质疏松的关系。结果：3组间年龄、病程、女性绝经及糖皮质激素应用构成比比较，差异有统计学意义（P < 0.05）；3组髋关节BMD明显低于腰椎BMD（P < 0.05）；骨质疏松组β-CTX、ESR、RF与骨量正常组比较，差异有统计学意义（P < 0.05）；年龄与绝经是类风湿关节炎继发骨质疏松的独立危险因素。结论：类风湿关节炎患者血清炎症指标、自身抗体及骨代谢指标水平存在不同程度异常，年龄与绝经后女性是类风湿关节炎继发骨质疏松的独立危险因素，骨量异常程度与β-CTX、ESR、RF等有关，不同骨骼部位BMD存在差异。

　　【关键词】　类风湿关节炎；骨质疏松；骨量异常；危险因素；临床因素

Analysis of Clinical Related Factors of Abnormal Bone Mass in Patients with Rheumatoid Arthritis

CHEN Shui-mian,ZHENG Hui-fu,XU Chao-chen,RAO Hua-chun,WU Zhen-bin

　　【ABSTRACT】Objective:To explore the characteristics of clinical related factors of abnormal bone mass in patients with rheumatoid arthritis.Methods:119 patients with rheumatoid arthritis were selected and their bone mineral density was measured by dual energy X-ray absorptiometry.According to the bone mineral density,the patients were divided into 55 cases in osteoporosis group,38 cases in osteopenia group and 26 cases in normal bone mass group.The age,course of disease,menopause or not,C-reactive protein（CRP）,rheumatoid factor （RF）,erythrocyte sedimentation rate（ESR）,25 hydroxyvitamin D3［25-（OH）D3］,total type I collagen amino terminal propeptide（TPINP）,β Collagen specific sequence（β-CTX） and bone mineral density（BMD） were analyzed and compared.The relationship between the above indexes and osteoporosis in patients with rheumatoid arthritis was analyzed by multivariate logistic regression.Results:There were significant differences in age,course of disease,female menopause and the constituent ratio of glucocorticoid application among three groups（P < 0.05）;The BMD of hip joint in three groups was significantly lower than that of lumbar spine（P < 0.05）;There was significant difference in β-CTX,ESR and RF between the osteoporosis group and the nomal bone mass group（P < 0.05）;Age and menopause are independent risk factors for osteoporosis secondary to rheumatoid arthritis.Conclusion:The levels of serum inflammatory indexes,autoantibodies and bone metabolism indexes in patients with rheumatoid arthritis are abnormal in varying degrees.Age and postmenopausal women are independent risk factors for osteoporosis secondary to rheumatoid arthritis,and the degree of abnormal bone mass is related to β-CTX,ESR,RF,etc.BMD of different bone parts is different.

　　【Keywords】 rheumatoid arthritis;osteoporosis;abnormal bone mass;risk factors;clinical factors