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类风湿关节炎患者脊柱骨质疏松性骨折临床危险因素分析

Exploration of risk factors on the occurrence of osteoporotic vertebral fracture in patients with rheumatoid arthritis

摘要:

目的 分析类风湿关节炎(RA)患者脊柱骨质疏松症(OP)和脊柱骨质疏松性骨折(OPF)的发生及其危险因素.方法 选RA患者644例(RA组),健康人158例(对照组),收集2组一般资料,包括糖皮质激素(以下简称激素)使用情况(日剂量、平均使用时间和累积量),摄X线脊柱正侧位片(胸椎5~腰椎5),测2组骨密度,判断2组有无OP和OPF的发生.危险因素分析采用多元线性和多元logistic回归分析.对发生脊柱OPF的相关因素进行ROC曲线分析.结果 (1)RA组脊柱OPF发生率为16.6% (107/644),腰椎骨密度明显降低[(0.97±0.22) g/cm2];腰椎2~4的OP发生率为17.9% (81/452),高于对照组4.4% (7/158)(P<0.001).(2)RA有OPF者腰椎2~4的OP发生率为40.6% (41/101),高于无OPF者11.4% (40/351) (P <0.001).有OPF者较无OPF者有更高的年龄、激素使用累积量、健康评估问卷(HAQ)评分、ESR及更长的激素使用时间、病程(P<0.05).(3)多元Logistic回归分析:年龄(OR=1.094,95% CI1.065~1.125)、性别(OR=5.600,95% CI2.097 ~ 15.087)为RA患者发生腰椎OP的危险因素,而BMI为RA患者发生腰椎OP的保护因素(OR=0.770,95% CI0.696 ~0.853).年龄(OR=1.031,95% CI1.009~1.053)、腰椎OP(OR =3.765,95% CI2.092 ~6.776)为RA患者发生脊柱OPF的危险因素.校正年龄、性别和BMI后,RA是发生脊柱OPF的危险因素(OR =4.716,95% CI 1.987 ~ 11.192).(4)RA患者发生脊柱OPF的ROC曲线分析:年龄与发生脊柱OPF的AUCRoC为0.689,截止年龄为54.5岁(P<0.001);激素日剂量与发生脊柱OPF的AUCRoC为0.636,截止激素日剂量为6.25 mg(P <0.001);激素疗程与发生脊柱OPF的AUCROC为0.685,截止激素使用时间为135 d(P <0.001).结论 RA患者脊柱OPF发生率明显升高.高龄、脊柱发生OP是导致OPF的危险因素.

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abstracts:

Objective To explore the prevalence of osteoporosis (OP) and vertebral osteoporotic fracture (OPF) and related risk factors in patients with rheumatoid arthritis (RA).Method A total of 644 patients with RA from Jan.2010 to Oct.2013 were recruited,anteroposterior and lateral X-rays examination of vertebral column (T5-L5) were conducted,and semi-quantity method were used as the standard for judging vertebral OPF.Meanwhile,patients' clinical and laboratory data including daily dosage of glucocorticoid,duration of glucocorticoid usage,cumulative amount dosage of glucocorticoid were recorded in details.158 normal subjects were selected as control group.Results (1)The prevalence of vertebral OPF in patients with RA was 16.6%.Bone mineral density (BMD) of all measured lumbar vertebra in RA group were markedly decreased[(0.97 ±0.22) g/cm2].The total prevalence of OP at lumbar vertebra in RA was 17.9% (81/452),which was significantly higher than that of control group (4.4%,7/158) (P < 0.001).(2) The percentage of OP in RA patients with vertebral OPF was significantly higher than that in patientswithout OPF [40.6% (41/101) vs 11.4% (40/351) ;P < O.001].Patients with OPF were of older age,longer use of glucocorticoid,more cumulative amount dosage of glucocorticoid,longer disease duration,higher scores of health assessment questionnaires (HAQ) and increased ESR (P < 0.05).(3) Logistic regression analysis revealed that age (OR =1.094,95% CI 1.065-1.125,P <0.001) and gender(1 =male,2 =female) (OR=5.600,95% CI 2.097-15.087,P =0.001) were the risk factors for the development of OP in RA,while body mass index (BMI) was the protective factor (OR =0.770,95% CI 0.696-0.853,P < 0.001).Age (OR =1.031,95% CI 1.009-1.053,P =0.005) and occurrence of OP at lumbar vertebra (OR =3.765,95% CI 2.092-6.776,P < 0.001) were risk factors of the development of OPF in RA patients.Logistic regression analysis also showed that RA was the risk factor of OPF (OR =4.716,95% CI 1.987-11.192,P < 0.001),even after the adjustment of age,gender and BMI.(4) Receiver operator characteristic(ROC) curve in RA patients with OPF has found that age-OPF and daily dosage of glucocorticoid-OPF AUCRoC were 0.689 and 0.636 respectively.The cut-off value in ROC curve of age and daily dose or treatment course of glucocorticoid-OPF were 54.5 years and 6.25 mg(P <0.001),while duration of glucocorticoid usage-OPF AUCROC was 0.685,with cut-off value in ROC of age-OPF 135 days(P < 0.001).Conclusion Prevalence of OPF in patients with RA increases remarkably.Old age and OP at spine are risk factors related to the development of OPF in patients with RA.

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作者: 刘文 [1] 徐胜前 [1] 马喜喜 [1] 胡琳玮 [1] 彭丽萍 [1] 徐建华 [1]
期刊: 《中华内科杂志》2014年53卷11期 852-857页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0578-1426.2014.11.004
发布时间: 2014-12-02
基金项目:
安徽省自然科学基金
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