刘伟; 宋慧; 满斯亮; 李宏超; 董鹏

doi:10.3760/cma.j.c141217-20200410-00148

点赞 0
分享 0
收藏 0
纠错

• 临床研究 •

放射学髋关节损害的强直性脊柱炎骨强度分析

中华风湿病学杂志, 2021,25(4) : 241-246. DOI: 10.3760/cma.j.c141217-20200410-00148

摘要

目的

分析放射学髋关节损害的AS患者骨强度指数、骨质疏松及骨折情况，探索该类患者骨强度变化的特点。

方法

分析跟骨超声的骨强度指数与双能X线吸收法骨密度（DXA）值（全髋，g/cm²）之间的相关性，采用Pearson相关统计分析。纳入研究的339例AS患者依据Bath AS髋关节放射学指数（BASRI-hip）评分分组，采用t检验、Mann-Whitney U秩和检验及χ²检验统计分析比较各组骨强度差异。Logistic回归分析骨强度低于同龄人的相关因素。

结果

①跟骨超声骨强度指数与DXA（全髋，g/cm²）呈正相关（r=0.553，P<0.01）。②放射学髋关节损害组年龄27（23，37）岁低于无放射学髋关节损害组37（28，48）岁，差异有统计学意义（Z=-5.986，P<0.01）。2组性别及病程相比差异均无统计学意义（P均>0.05）。③在<50岁的AS患者中，与无放射学髋关节损害组相比，放射学髋关节损害组骨强度指数降低（78±18与84±16）、骨强度低于同龄人比率升高（41.0%与18.4%）、骨质疏松发生率升高（42.7%与28.8%）、脆性骨折发生率升高（3.7%与0%），差异均有统计学意义（t=3.028，P<0.01；χ²=16.758，P<0.01；χ²=5.886，P=0.019；χ²=4.67，P=0.038）。在≥50岁的AS患者中，2组上述指标相比差异均无统计学意义（P>0.05）。④多因素分析结果显示放射学髋关节损害[OR值（95%CI）=1.912（1.05，3.48）]、年龄[OR值（95%CI）=0.94（0.911，0.97）]及BMI（kg/m²）[OR值（95%CI）=0.875（0.807，0.948）]与AS患者骨强度低于同龄人相关。

结论

跟骨骨强度指数与DXA骨密度值呈正性强相关。放射学髋关节损害的AS骨强度降低，骨质疏松及脆性骨折发生风险升高。放射学髋关节损害、年龄及BMI与AS患者骨强度降低相关。

引用本文: 刘伟, 宋慧, 满斯亮, 等. 放射学髋关节损害的强直性脊柱炎骨强度分析 [J] . 中华风湿病学杂志, 2021, 25(4) : 241-246. DOI: 10.3760/cma.j.c141217-20200410-00148.

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

扫描看全文

正文

作者信息

基金 0 关键词 0

English Abstract

阅读 0 评论 0

相关资源

引用 | 论文 | 视频

版权归中华医学会所有。

未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

AS是一种慢性炎症疾病，发病高峰在20~30岁，炎性腰背痛、附着点炎、骶髂关节炎及脊柱骨赘形成是主要临床特征^[1]。AS还可以损害髋关节，文献[2,3]报道AS髋关节受累比率为19%~47%，髋关节损害也是该病致残原因之一^[4]。髋关节损害的AS患者病情更严重，表现为脊柱病变更重，更容易发生附着点炎及外周关节炎^[2]。然而，针对髋关节损害的AS骨强度情况的研究较少。而且，髋关节损害导致走路姿势和步态变化，这类患者更容易跌倒，了解此类患者骨强度变化十分重要^[5]。骨强度包括骨量和骨质两方面，双能X线吸收法骨密度（dualenergy X-ray absorptiometry，DXA）主要反映骨量，仅可以代表60%~70%的骨强度，不能反映骨微结构、构造和重建。跟骨超声法骨强度可以弥补DXA法的不足，而且此方法方便、快捷、成本低^[6]。本研究回顾性分析了339例AS临床资料，以跟骨超声法测量骨强度，探索放射学髋关节损害的AS患者骨强度变化特点。

贡献者信息

刘伟

北京积水潭医院风湿免疫科　100035

宋慧

北京积水潭医院风湿免疫科　100035

满斯亮

北京积水潭医院风湿免疫科　100035

李宏超

北京积水潭医院风湿免疫科　100035

董鹏

北京积水潭医院风湿免疫科　100035

通信作者

宋慧

北京积水潭医院风湿免疫科　100035

Email：jst_fsmy@163.com

关键词

脊柱炎，强直性; 骨质疏松性骨折; 骨强度;

利益冲突

所有作者均声明不存在利益冲突

历史

出版日期：2021-04-15

收稿日期：2020-04-10

本文编辑

张跃

Clinical Research

Analysis of bone strength in ankylosing spondylitis patients with radiographic hip involvement

Liu Wei, Song Hui, Man Siliang, Li Hongchao, Dong Peng

Published 2021-04-15

Cite as Chin J Rheumatol, 2021, 25(4): 241-246. DOI: 10.3760/cma.j.c141217-20200410-00148

Abstract

Objective

To analyze bone strength index, osteoporosis and fracture in ankylosing spondylitis (AS) patients with radiologic hip involvement and explore the characteristics of bone strength in these patients.

Methods

According to bath ankylosing spondylitis radiology hip index (BASRI-hip) score, 339 AS patients were divided into two groups. The differences of bone strength in each group were analyzed by t-test, Mann-Whitney U test and χ² test. Logistic regression was used to analyze the risk factors of bone strength index. The correlation between quantitative ultrasound and dualenergy X-ray absorptiometry (DXA) (total hip, g/cm²) was analyzed. Pearson correlation analysis was used.

Results

①Bone strength index of quantitative ultrasound was positively correlated with bone mineral density of DXA (total hip, g/cm²), r=0.553, P<0.01. ② The age of 27(23, 37) years old in radiographic hip involvement was lower than 37(28, 48) years old in non-radiographic hip involvement, and the difference was statistically significant (Z=-5.986, P<0.01). There were no differences in gender and course of disease between the two groups (P>0.05).③ The radiographic hip involvement in AS patients whose ages were younger than 50, when compared with non-radiographic hip involvement patients, the bone strength index was lower (78±18vs 84±16), while bone strength was lower than patients at the same age (41.0% vs 18.4%), however, the incidences of osteoporosis (42.7% vs 28.8%) and fragility fracture (3.7% vs 0%) were significantly higher (t=3.028, P<0.01;χ²=16.758, P<0.01;χ²=5.886, P=0.019; χ²=4.67, P=0.038). For AS patients whose ages were ≥50, there were no significant differences between the two groups (P>0.05). ④ Multivariate analysis showed that radiographic hip involvement [OR (95% CI)=1.912(1.05, 3.48)], age [OR (95% CI)=0.94(0.911, 0.97)] and body mass index (BMI) (kg/m²) [OR (95% CI) =0.875(0.807, 0.948)] were associated with lower bone strength.

Conclusion

There is positive correlation between the bone strength index of quantitative ultrasound and bone mineral density of DXA. AS patients with radiographic hip involvement are characterized by decreased bone strength and are more likely to develop osteoporosis and fragile fractures. The risk factors of low bone strength are radiographic hip involvement, age and BMI.

Key words:

Spondylitis, ankylosing; Osteoporotic; Fracture; Bone strength

Contributor Information

Liu Wei