强直性脊柱炎患者骨密度异常的危险因素分析

The risk factors of bone mineral density abnormality in patients with ankylosing spondylitis

中文关键词:  强直性脊柱炎  骨密度  骨质疏松  危险因素

英文关键词:Ankylosing spondylitis  Bone mineral density  Osteoporosis  Influence factors

中文摘要:

  【摘要】 目的：探索强直性脊柱炎（ankylosing spondylitis，AS）患者发生骨密度异常的危险因素。方法：调查选取2018年5月～2019年5月来本院就诊的AS患者年龄、病程、血沉（erythrocyte sedimentation rate，ESR）、C-反应蛋白（C-reactive protein，CRP）等炎症指标和枕墙距、胸廓活动度等体格检查情况。选取同期健康人作为对照组。使用双能X线骨密度吸收仪测定AS患者及对照组股骨颈、大转子、腰椎及全髋关节骨密度情况，并采用独立样本t检验进行组间差异性比较。同时采用Pearson相关性分析，探索AS患者各部位骨密度异常情况与病程、年龄、炎症指标等的相关性，采用多元线性回归分析AS骨密度异常的危险因素。结果：本次研究共纳入23例AS男性患者，平均年龄36.6±5.9岁，20名健康成年男性对照，平均年龄38.9±4.0岁（P>0.05）。病例组中位病程5（3，7）年。病例组股骨颈（0.86±0.17）、大转子（0.85±0.12）、腰椎（0.90±0.10）、全髋关节（0.88±0.16）骨密度均低于对照组（0.98±0.21、0.94±0.15、1.16±0.14及0.99±0.19），差异有统计学意义（P<0.05）。病例组患者股骨颈、全髋关节骨量异常与病程、年龄、炎症指标、枕墙距和指地距呈负相关，与胸廓活动度和脊柱活动度呈正相关（P<0.05）。大转子骨密度异常与年龄、ESR、CRO、枕墙距呈负相关，与胸廓活动度和脊柱活动度呈正相关（P<0.05）。单因素分析发现病程、ESR、CRP、指地距、胸廓活动度与AS骨质异常相关（P＜0.05），多元线性回归分析结果表明病程（b=1.33，P=0.01）、ESR（b=0.75，P=0.04）为AS骨密度异常的独立危险因素。结论：AS患者股骨颈、大转子、腰椎及全髋关节骨密度均低于同龄健康人，股骨颈、全髋关节骨量异常与病程、年龄、炎症指标、枕墙距和指地距、胸廓活动度和脊柱活动度有关联，而病程、ESR为AS骨密度异常的独立危险因素。

英文摘要:

  【Abstract】 Objectives: To explore the risk factors for bone mineral density(BMD) abnormality in patients with ankylosing spondylitis(AS). Methods: A retrospective study of patients with AS who came to our hospital from May 2018 to May 2019 were involved. Data of age, duration of disease, erythrocyte sedimentation rate (ESR), C-reactive protein(CRP) and physical examinations such as wall distance and thoracic activity was evaluated. Healthy people in the same period were included to control group. Dual-energy X-ray absorptiometry(DXA) was used to record bone mineral density of femoral neck and lumbar spine in both AS group and control group. Two independent samples t-test were conducted to compare the differences between both groups. And Pearson correlation analysis was used to explore the potential influencing factors of abnormal BMD in patients with AS. Cox regression was used to analyze the risk factors of abnormal bone mineral density in AS. Results: A total of 23 male AS patients and 20 age-matched healthy adult male controls were included in this study. The mean age of AS group was 36.57±5.93 years, and 38.85±4.03 years of control group(P>0.05). The average duration of the case group was 5(3, 7) years. The BMD of the femoral neck(0.86±0.17), greater trochanter(0.85±0.12), lumbar spine(0.90±0.10) and total hip joints(0.88±0.16) in case group was statistically significant lower than that of the control group(0.98±0.21, 0.94±0.15, 1.16±0.14 and 0.99±0.19 respetively, P<0.05). In AS group, the abnormal BMD of femoral neck and total hip joints was negatively correlated with disease duration, age, inflammation index, pillow wall distance and finger distance, and positively correlated with thoracic activity and spinal activity(P<0.05). Abnormal BMD of the greater trochanter was negatively correlated with age, ESR, CRO, and occipital wall distance, and positively correlated with thoracic activity and spinal activity(P<0.05). Univariate analysis found that disease course, ESR, CRP, finger distance, and thoracic activity were related to AS bone abnormalities(P<0.05). Multiple linear regression analysis showed that disease course(b=1.33，P=0.01) and ESR(b=0.75，P=0.04) were independent risk factors for AS bone density abnormalities. Conclusions: The BMD of the femoral neck, greater trochanter, lumbar spine and total hip joints in patients with AS is lower than that of healthy population of the same age. The abnormal BMD of the femoral neck and total hip joints were associated with the course of disease, age, inflammation index, pillow wall distance and fingertips distance, thoracic activity, and spinal activity. The course of disease and ESR are independent risk factors for abnormal bone mineral density in AS.