目的 分析强直性脊柱炎(AS)患者骨密度下降的临床特征及其危险因素。方法 回顾2017-01至2023-11联勤保障部队第962医院收治的AS患者110例。应用双能X线吸收法测定骨密度并进行分组,分为正常组(T值＞-1)和下降组(T值≤-1)。采用单因素分析骨密度下降的特征,采用多因素logistic分析骨密度下降的危险因素。结果 AS患者年龄中位数25.50(21.00,32.00)岁,病程中位数1.00(0.70,3.00)年,男109例,女1例。骨密度正常74例,骨密度下降36例,其中低骨量32例,骨质疏松4例。接受重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白治疗62例。单因素分析提示年龄、病程、C反应蛋白、红细胞沉降率与骨密度下降相关(P<0.05),多因素logistic分析提示年龄(OR=1.14,95%CI:1.05～1.25)、C反应蛋白(OR=1.09,95%CI:1.02～1.15)、红细胞沉降率(OR=1.03,95%CI:1.00～1.07)是骨密度下降的风险因素,应用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白(OR=0.27,95%CI:0.10～0.76)是骨密度下降的保护性因素。结论 年龄、C反应蛋白、红细胞沉降率是AS患者骨密度下降的危险因素,应用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白是骨密度下降的保护性因素。
Abstract
Objective To analyze the clinical characteristics and risk factors of decreased bone mineral density (BMD) in patients with ankylosing spondylitis (AS). Methods A total of 110 AS patients admitted to the 962nd Hospital of PLA Joint Logistics Support Force from January 2017 to November 2023 were reviewed. DXA method was used to measure BMD and the patients were divided into normal group(T-score＞-1) and decreased group(T-score≤-1).The characteristics associated with decreased BMD were analyzed using univariate analysis, and the risk factors of decreased BMD were examined using multivariate logistic regression analysis. Results The median age of AS patients in Heilongjiang Province was 25.50(21.00,32.00) years,and the median disease duration was 1.00(0.70,3.00) years, with 109 male and 1 female. BMD was normal in 74 cases, and BMD decreased in 36 cases, including low bone mass in 32 cases and osteoporosis in 4 cases. A total of 62 cases received recombinant human tumor necrosis factor receptor type Ⅱ antibody fusion protein. Univariate analysis showed that age, disease course,CRP,and ESR were associated with BMD decrease(P<0.05). Multivariate logistic analysis indicated that age(OR=1.14,95%CI:1.05～1.25),CRP(OR=1.09,95%CI:1.02～1.15),and ESR(OR=1.03,95%CI:1.00～1.07)were risk factors for BMD decrease,and recombinant human tumor necrosis factor receptor type II antibody fusion protein(OR=0.27,95%CI:0.10～0.76)was a protective factor against BMD decrease. Conclusions Age,CRP and ESR are risk factors for BMD decrease in patients with AS, while recombinant human tumor necrosis factor receptor type Ⅱ antibody fusion protein acts as a protective factor against BMD decrease.
关键词
强直性脊柱炎 /
骨密度 /
骨质疏松 /
双能X线吸收测定法 /
危险因素
Key words
ankylosing spondylitis /
bone mineral density /
osteoporosis /
DXA /
risk factor
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参考文献
[1] Sieper J,Poddubnyy D.Axial spondyloarthritis[J]. Lancet,2017,390(10089):73-84.
[2] 黄 烽,朱 剑,王玉华,等.强直性脊柱炎诊疗规范[J].中华内科杂志,2022,61(8):893-900.
[3] 张奕楠,冀肖健,胡嘉文,等.强直性脊柱炎患者合并附着点炎的临床特征分析[J].解放军医学院学报,2022,43(3):264-269.
[4] 周泽霖,尚 奇,卓 航,等.男性原发骨质疏松症骨密度与新型炎症指标的相关性[J].中国骨质疏松杂志,2023,29(5):636-640,646.
[5] 戴 岷,谈 裔.强直性脊柱炎合并髋关节累及患者骨质疏松症发病概况及相关因素分析[J]. 中国骨质疏松杂志,2017,23(7):856-859.
[6] 樊宇宇,丁立祥,宋红星,等.骨质疏松性椎体骨折级联的风险因素[J].中国骨质疏松杂志,2023,29(2):199-203.
[7] 王欣荣,徐胜前,龚 勋,等.强直性脊柱炎患者X线脊柱结构损伤的影响因素分析[J].中华风湿病学杂志,2019,23(11):735-741.
[8] Zhang M,Li X M,Wang G S,et al. The association between ankylosing spondylitis and the risk of any,hip,or vertebral fracture:a meta-analysis[J]. Medicine,2017,96(50):e8458.
[9] Patel P, Hussain H, Fahey J. Delayed diagnosis of ankylosing spondylitis:a missed opportunity?[J]. Cureus,2019,11(9):e5723.
[10] Mühlenfeld M,Strahl A,Bechler U,et al. Bone mineral density assessment by DXA in rheumatic patients with end-stage osteoarthritis undergoing total joint arthroplasty[J].BMC Musculoskelet Disord,2021,22(1):173.
[11] Heijde D, Braun J, Deodhar A,et al. Modified stoke ankylosing spondylitis spinal score as an outcome measure to assess the impact of treatment on structural progression in ankylosing spondylitis[J]. Rheumatology,2019,58(3):388-400.
[12] 冯秀媛,莫凌菲,俱博苗,等.初发结缔组织病患者低骨量及其相关危险因素分析[J].中国骨质疏松杂志,2016,22(7):809-814.
[13] Kim J W,Park S,Jung J Y,et al. Prevalence and factors of osteoporosis and high risk of osteoporotic fracture in patients with ankylosing spondylitis:a multicenter comparative study of bone mineral density and the fracture risk assessment tool[J]. J Clin Med,2022,11(10):2830.
[14] 卢兆安,王传文,吕晓龙,等.强直性脊柱炎患者骨密度异常的危险因素分析[J].中国脊柱脊髓杂志,2020,30(6):546-551.
[15] Ramírez J, Nieto-González J C, Curbelo-Rodríguez R,et al. Prevalence and risk factors for osteoporosis and fractures in axial spondyloarthritis:a systematic review and meta-analysis[J]. Semin Arthritis Rheum,2018,48(1):44-52.
[16] 张 亮,李宏超,宋 慧,等.强直性脊柱炎与骨质疏松[J].中华骨与关节外科杂志,2019,12(11):915-918.
[17] Sharif K,Tsur A M,Ben-Shabat N,et al. The risk of osteoporosis in patients with ankylosing spondylitis-a large retrospective matched cohort study[J]. Med Clin(Barc),2023,160(9):373-378.
[18] 胡劲涛,柴 乐,任伟凡,等.强直性脊柱炎骨代谢的研究进展[J].中国骨质疏松杂志,2019,25(6):875-879.
[19] 路 平,阎小萍.强直性脊柱炎合并骨质疏松症患者临床特点、骨密度及骨代谢相关指标的研究[J].中华骨质疏松和骨矿盐疾病杂志,2012,5(1):12-19.
[20] El M A,Ebo’o F B,Sadni S,et al. Is there a relation between pre-sarcopenia,sarcopenia,cachexia and osteoporosis in patients with ankylosing spondylitis?[J]. BMC Musculoskelet Disord,2016,11(17):268.
[21] Ulu M A,Batmaz I,Dilek B,et al. Prevalence of osteoporosis and vertebral fractures and related factors in patients with ankylosing spondylitis[J]. Chin Med J,2014,127(15):2740-2747.
[22] 苏晓燕,林志翔,张春霞,等.强直性脊柱炎并发骨质疏松患者临床特征分析[J].吉林医学,2014,35(18):4011-4012.
[23] Hinze A M,Louie G H.Osteoporosis management in ankylosing spondylitis[J]. Curr Treatm Opt Rheumatol,2016,2(4):271-282.
[24] 覃永婷,韦建勋,李柱海,等.强直性脊柱炎合并骨质疏松症的治疗研究进展[J].中国骨质疏松杂志,2022,28(3):450-454.
[25] Ashany D,Stein E M,Goto R,et al. The effect of TNF inhibition on bone density and fracture risk and of IL-17 inhibition on radiographic progression and bone density in patients with axial spondyloarthritis:a systematic literature review[J]. Curr Rheumatol Rep,2019,21(5):20.
[26] Nigil H N,Sriganthan J,Al G N,et al.Effect of TNF-a inhibitor treatment on bone mineral density in patientswith ankylosing spondylitis:a systematic review and meta-analysis[J].Semin Arthritis Rheum,2014,44(2):155-161.
[27] 钟驾云,吴 歆,徐沪济.强直性脊柱炎合并骨质疏松或骨量减少临床研究进展[J].诊断学理论与实践,2019,18(1):109-112.
基金
哈尔滨市科技计划项目(ZC2023ZJ004022)
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