本文選題：類風(fēng)濕關(guān)節(jié)炎 + 骨質(zhì)疏松性骨折　； 參考：《中國骨質(zhì)疏松雜志》2017年02期

【摘要】：目的探討少肌癥和維生素D缺乏在RA患者脊柱骨質(zhì)疏松性骨折(OPF)中的臨床意義。方法入選936例RA患者和158例年齡、性別相匹配的正常健康者,所有入選對象均攝脊柱正側(cè)位X線片(T5-L5),并以半定量(SQ)法作為判斷脊柱OPF的標(biāo)準(zhǔn),其中648例RA患者和對照組采用DXA法測定了腰椎和髖部骨密度(BMD),267例RA患者和156例對照組以生物電阻抗法測定了四肢骨骼肌質(zhì)量,化學(xué)發(fā)光法測定了234例RA患者和68例對照組血清25(OH)D水平,同時詳細(xì)記錄RA患者各臨床及實驗室指標(biāo)等情況。結(jié)果 1RA患者中(141/936,15.1%)OPF的發(fā)生率明顯高于對照組(6/158,3.8%)(χ2=18.658,P0.0001);少肌癥的發(fā)生率明顯高于對照組(55.8%,149/267 vs 9.0%,14/156,χ2=91.176,P0.0001);RA組血清25(OH)D水平明顯低于對照組[(13.41±9.71)ng/m L,(22.40±6.26)ng/m L,t=9.063,P0.0001],維生素D缺乏發(fā)生率明顯高于對照組[80.8%(189/234)vs 36.8%(25/68),χ2=49.412,P0.0001]。2RA患者OPF組25(OH)D水平明顯低于無OPF組[(12.28±5.67)ng/m L vs(17.16±10.90)ng/m L,t=2.600,P=0.01];各部位肌肉量均明顯低于無OPF組(P0.01~0.05)。3線性相關(guān)分析發(fā)現(xiàn):RA患者的25(OH)D與骨骼肌、右上肢、左上肢和軀干肌肉量呈正直線相關(guān)關(guān)系(P0.05);RA患者的骨骼肌質(zhì)量與髖部、腰椎各部位BMD呈正直線相關(guān)關(guān)系(P0.05)。4多元回歸分析顯示:女性、HAQ積分和總氈部OP的發(fā)生為RA患者發(fā)生少肌癥的危險因素;年齡為RA患者發(fā)生脊柱OPF的危險因素,骨骼肌質(zhì)量指數(shù)(SMI)為RA患者發(fā)生脊柱OPF的保護(hù)因素。結(jié)論 RA患者具有高于正常健康者脊柱OPF的發(fā)生率,其25(OH)D水平缺乏普遍存在,少肌癥發(fā)生率增高;RA患者維生素D缺乏、少肌癥與RA患者脊柱OPF的發(fā)生密切相關(guān)。
[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 鹵9.71) ng/m L, (22.40 鹵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 鹵5.67) ng/m / L vs (17.16 鹵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.
【作者單位】： 安徽醫(yī)科大學(xué)第一附屬醫(yī)院風(fēng)濕免疫科;
【分類號】：R593.22;R580;R683

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本文編號：2112854