李声东

[摘要] 目的 探讨RA活动度、病程以及生物制剂对骨密度的影响。 方法 选取2013年3月～2016年1月135例绝经后女性RA患者并随访1年。根据是否使用双膦酸盐分为两组。检测患者血清：BGP、β-CTX。计算RA 患者疾病活动指数（DAS28 评分，CDAI、SDAI）和HAQ评分；用DEXA 检测各组受试者腰椎及股骨颈及全髋骨密度（BMD）；记录患者是否使用生物制剂治疗。用单因素回归及多因素回归分析各变量和骨密度的关系。 结果 多元线性回归分析提示病程和股骨颈及全髋的骨密度存在显著关系。生物制剂的使用和骨密度无显著性相关。 结论 绝经后女性RA患者的髋部骨密度取决于病程，无论是否使用双膦酸盐。生物制剂使用和骨丢失无显著相关性。

[关键词] 类风湿关节炎；骨质疏松； 疾病活动度；双膦酸盐；生物制剂

[中图分类号] R593.22 [文献标识码] A [文章编号] 1673-9701（2018）15-0009-05

Influencing factors of bone mineral density in postmenopausal women with rheumatoid arthritis

LI Shengdong

Department of Rheumatology and Immunology， the Second Hospital of Yinzhou District of Ningbo City， Ningbo 315000， China

[Abstract] Objective To explore the effects of activity and duration of RA and biological agents on bone mineral density. Methods From March 2013 to January 2016， 135 cases of postmenopausal women with RA were selected and followed up for 1 year. Participants were divided into two groups according to whether they used bisphosphonates or not. Serum BGP and β-CTX of patients were detected. The disease activity index（DAS28 score， CDAI， SDAI） and HAQ score of RA patients were calculated. The bone mineral density（BMD） of lumbar vertebrae， femoral neck and total hip were measured by DEXA. Whether the patients were treated with biological agents was recorded. The relationship between variables and bone mineral density was analyzed by univariate and multivariate regression. Results Multiple linear regression analysis showed that there was a significant linear relationship between the course of disease and the bone mineral density of femoral neck and total hip. There was no significant correlation between the use of biological agents and bone mineral density. Conclusion Hip bone mineral density in postmenopausal women with RA is dependent on the course of disease， regardless of whether bisphosphonates are used or not. There was no significant correlation between the use of biological agents and bone loss.

[Key words] Rheumatoid arthritis； Osteoporosis； Disease activity； Bisphosphonates； Biological agents

骨質疏松症是类风湿关节炎（Rheumatoid arthritis，RA）的常见合并症，RA患者中骨质疏松症的发生率在15%～20%[1]。骨质疏松增加RA患者发生脆性骨折的风险，并且骨质疏松相关骨折显著增加致残率、死亡率及医疗保健费用支出。另外，RA患者骨质疏松的发生和炎症因子的增加、活动量减少、糖皮质激素和慢作用药物（disease-modifying antirheuma-tic drugs，DMARDs）的使用和年龄及绝经状态相关[2]。许多研究表明疾病相关的人口学特征与RA患者的骨密度相关。然而，由于患者的选择、样本量大小及研究设计的不同，骨密度丢失的危险因素在相关研究中又多少有些不一致[3-5]。而且，疾病活动度、活动量和药物的使用，包括糖皮质激素、生物制剂、双膦酸盐等之间的复杂相互关系可能影响骨密度的变量。……