绝经后女性类风湿关节炎患者骨密度的临床研究.doc

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1、绝经后女性类风湿关节炎患者骨密度的临床研究作者：臧谋圣，张林杰，徐胜前，徐建华，李群【摘要】目的探讨绝经后女性类风湿关节炎（RA）患者骨密度（BMD）的变化及其骨质疏松（OP）的发生情况。方法采用双能X线骨密度仪，测量45例女性RA患者（绝经前26例和绝经后19例）和45例正常女性（绝经前24例和绝经后21例）的前臂、腰椎2～4以及股骨颈、Ward区和大转子的BMD，并同时测定RA患者各临床及实验室指标。结果19例绝经后女性RA患者中，11例患者（57.9%）有至少1个检测部位为OP，7例患者（36.8%）表现为至少1个检测部位骨量低下，总体骨量丢失较绝经前RA患者明显（P<0.0001

2、），与正常绝经后女性无差别（P>0.05）。除桡骨远端外，绝经后RA患者各测定部位BMD均低于绝经前患者（P<0.05）；绝经后女性RA患者股骨Ward区和2～4BMD低于正常绝经后女性（P<0.05），其余各测定部位的BMD与正常绝经后女性间差别无统计学意义（P>0.05）。LogisticRegression分析显示绝经：OR=14.144[(2.303-86.877)，P=0.004]为女性RA患者骨质疏松发生的相关因素。结论绝经后女性RA患者的BMD明显降低，骨量丢失较绝经前RA患者明显。绝经和关节炎的严重程度为女性RA患者OP发生的危险因素。【关键词】类风湿关

3、节炎；骨密度；骨质疏松Abstract：ObjectiveToinvestigatethechangeinbonemineraldensity(BMD)andtheprevalenceofosteoporosis(OP)inpostmenopausalfemalepatientswithrheumatoidarthritis(RA).MethodsBMDofnondominantforearm,lumbarvertebrae(L2-4)andhipweremeasuredbydualenergyXrayabsorptiometryin45femalepatientswithRA(26pre

4、menopausal,19postmenopausal)andin45healthyfemalesubjects(24premenopausal,21postmenopausal).Clinicalorlaboratoryindexeswerealsomeasuredinthemeantime.ResultsThetotalbonelossofpostmenopausalfemalepatientswithRAwassevererthanthatofpremenopausalpatients(P<0.0001),andwassimilartothatofnormalpostmenopau

5、salfemalesubjects(P>0.05).BMDofallthedetectedsitesweresignificantlowerinthepostmenopausalfemalepatientswithRAthaninthepremenopausalpatients(P<0.05)exceptBMDofnondominantforearm.BMDofWarddomainandgreatertrochanterofhipinpostmenopausalfemalepatientswithRAwassignificantlowerthanthatinthenormalpos

6、tmenopausalfemale(P<0.05).LogisticregressionanalysisshowedthatmenopausewasafactorcorrelatedwithosteoporosisinfemalepatientswithRA[OR=14.144(2.303-86.877),P=0.004].ConclusionThereisobviouslyreductioninBMDinpostmenopausalfemaleswithRA.Thetotalbonelossisseverer,comparedwiththatofpremenopausal5patien

7、ts.MenopauseandjointinflammationareriskfactorswhichhelptodevelopOPinfemalepatientswithRA.Keywords：rheumatoidarthritis;bonemineraldensity;osteoporosis类风湿关节炎（RheumatoidArthritis，RA）是一种慢性进行性可导致骨质破坏的自身免疫病