前臂骨密度与骨代谢指标对绝经后女性类风湿性关节炎合并骨质疏松的诊断价值

doi:10.3969/j.issn.2095-9400.2020.03.015

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摘要目的：探讨前臂骨密度（BMD）与骨代谢指标对绝经后女性类风湿性关节炎（RA）合并骨质疏松（OP）的诊断价值。方法：采用双能X线吸收法（DXA）测定96例绝经后女性RA患者和25例绝经后健康女性对照者的前臂BMD、骨矿含量（BMC），并收集、测定其年龄、BMI、红细胞沉降率、C反应蛋白、类风湿因子、I型原胶原N-端前肽（PINP）和血清I型胶原交联C-末端肽（β-CTX）水平等骨代谢指标，分析BMD与实验指标的相关性。结果：RA组前臂BMD及BMC较对照组低，差异有统计学意义（P＜0.01）；RA组骨代谢指标PINP为（79.01±44.72）μg/L，β-CTX为（0.51±0.35）μg/L；对照组PINP为（96.74±50.92）μg/L，β-CTX为（0.37±0.26）μg/L，2组比较差异有统计学意义（P＜0.05）；相关分析显示RA组β-CTX与BMD、BMC呈负相关（r=-0.259，P=0.011；r=-0.300，P=0.003）；年龄与BMD、BMC呈负相关（r=-0.706，P＜0.001；r=-0.743，P＜0.001）；DAS28与BMD、BMC呈负相关（r=-0.400，P＜0.001；r=-0.330，P=0.001）；PINP与BMD、BMC呈正相关（r=0.308，P=0.020；r=0.244，P=0.010）；logistic回归分析显示，年龄、β-CTX为发生OP的危险因素（OR=0.450，95%CI=0.606～0.921，P=0.006；OR=1.008，95%CI=1.002～1.016，P=0.031）；PINP为发生OP的保护性因素（OR=1.060，95%CI=1.005～1.118，P=0.003）。结论：绝经后女性RA患者较正常绝经后女性更易发生OP，骨代谢指标β-CTX可能为绝经后女性RA发生OP的独立危险因素。

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	徐晓作
	朱小春

关键词 ：类风湿关节炎, 骨密度, 骨代谢指标

Abstract：Objective: To investigate the value of forearm bone mineral density (BMD) and bone metabolism markers in the diagnosis of postmenopausal female rheumatoid arthritis (RA) with osteoporosis (OP). Methods: Ninety six postmenopausal female rheumatoid arthritis (RA) and 25 postmenopausal healthy female were determined by DXA. Age, body mass index, erythrocyte sedimentation, C reaction protein, rheumatoid factor, type I collagen N-terminal peptide (PINP) and serum type I collagen crosslinked C-terminal peptide (β-CTX) horizontal bone metabolism index were collected.The correlation between bone density and experimental index was analyzed. Results: Bone density and bone mineral content in RA group were significantly lower than those in the control group, P<0.01). Statistical differences were found between RA and control group in bone metabolism index PINP [(79.01±44.72)μg/L vs. (96.74±50.92)μg/L, P=0.036] and β-CTX [(0.51±0.35)μg/L vs. (0.37±0.26)μg/L, P=0.009]; Linear correlation analysis showed that β-CTX was negatively related to BMD and BMC (r=-0.259, P=0.011; r=-0.300, P=0.003) in RA; Age is negatively related to BMD and BMC (r=-0.706, P<0.001; r=-0.743, P<0.001); DAS28 is negatively related to BMD and BMC (r=-0.400, P<0.001; r=-0.330, P=0.001); PINP is positively correlated with BMD and BMC (r=0.308, P=0.020; r=0.244, P=0.010); The logistic regression analysis showed that only age, β-CTX were the risk factors for osteoporosis (OR=0.450, 95%CI=0.606-0.921, P=0.006; OR=1.008, 95%CI=1.002-1.016, P=0.031); PINP is a protective factor for osteoporosis (OR=1.060, 95%CI=1.005-1.118, P=0.003). Conclusion: Postmenopausal female RA patients are more prone to osteoporosis than normal postmenopausal female, and bone metabolism index β-CTX may be an independent risk factor for postmenopausal female RA osteoporosis.

Key words： rheumatoid arthritis bone density bone metabolism

通讯作者: 朱小春，教授，主任医师，硕士生导师，Email：zxc1616@aliyun.com。

作者简介: 徐晓作（1988-），女，浙江温州人，主治医师。

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https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2020.03.015 或 https://xb.wmu.edu.cn/CN/Y2020/V50/I3/241

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