男女强直性脊柱炎骨密度对比分析

摘要

Objective To study the bone mineral density ( BMD) and the related other clinical indicators in men and women with ankylosing spondylitis ( AS) .Methods The patients diagnosed with AS in China-Japan Friendship Hospital from March 2006 to December 2014, including 168 women and 587 men, aging from 20 to 45 years old, were retrospectively surveyed.BMD of the lumbar spine, femoral neck, and trochanter were measured using dual energy X-ray.The correlation analysis with age, disease duration, disease activity index, radiological indicators was performed.Results 1) Men with AS had significantly lower BMD in lumbar spine than women (p<0.01).The total incidences of osteoporosis (OP) and osteopenia (OT) in men with AS (71.04%) were higher than those in women with AS (42.86%, p<0.05).The incidences of OP and OT in the lumbar spine, femoral neck, and trochanter were significantly higher in men than in women (p<0.01).2) BMD of the lumbar spine in middle-age group (30 to 39 years old) and older-age group (40 to 45 years old) was lower in men with AS than in women with AS (p<0.01).In older age group, BMD of the femoral neck was significantly lower in men with AS than in women with AS (p<0.01).In patients with AS for 5 to 10 years or more, BMD of the lumbar spine and the femoral neck was significantly lower in men than in women ( p<0.01, p<0.01, p<0.01, p<0.05).3) Correlation analysis showed that in both men and women with AS, BMD was significant correlated with disease activity index (ESR,CRP), clinical signs, and Sacroiliac joint grading (p<0.05).BMD in men with AS was negatively correlated with age and disease duration (p<0.05).Conclusion The incidences of OT and OP are high in both men and women.It is more significantly in men, especially in BMD of the lumbar spine in men.The older and the longer the disease course, the more reduction of BMD in male patients.The decrease of BMD is associated with the extent of disease, disease activity, physical function, and HLA-B27 in both men and women with AS.Male patients need more attention in diagnosis and treatment of OT and OP.%目的：探讨男性和女性强直性脊柱炎（ Ankylosing Spondylitis，AS）患者骨密度（ Bone mineral density，BMD）及BMD与其他临床指标的相关性。方法回顾性调查2006年3月至2014年12月中日友好医院中医风湿病科确诊为AS的患者，其中女性168例，男性587例，年龄在20岁～45岁，双光能X线法检测腰椎、股骨颈、股骨粗隆的BMD，并与年龄、病程、疾病活动性指标、影像学指标进行相关分析。结果①男性AS患者腰椎BMD较女性腰椎BMD显著减低（ P＜0.01）；男性AS患者骨质疏松（Osteoporosis，OP）及骨量减少（Osteopenia，OT）总发生率为71.04％，显著高于女性AS患者的42.86％（P＜0.05），且在腰椎、股骨颈、股骨粗隆部位的OP、OT发生率均显著高于女性AS患者（P＜0.01）；②中年龄组（30～39岁）及高年龄组（40～45岁）的AS患者中男性腰椎BMD较女性显著降低（ P＜0.01）；高年龄组AS患者中男性股骨颈BMD较女性显著降低（ P＜0.01）；病程5～10年及大于10年的AS患者中男性腰椎、股骨颈BMD较女性显著降低（ P＜0.01、P＜0.01、P＜0.01、P＜0.05）③相关性分析显示男性与女性AS患者BMD与疾病活动指标ESR、CRP，体征、骶髂关节炎分级等有相关性，而男性AS患者BMD与年龄、病程尚呈显著负相关（ P＜0.05）。结论男女AS患者均有较高的OT、OP的发生率，且男性OT及OP的较之女性更为显著，特别是腰椎BMD男性AS患者减低更为突出。此外年龄越大、病程越长的男性AS患者BMD减低程度越明显。男性与女性AS患者BMD的下降均与疾病程度、病情的活动性、肢体活动功能、HLA-B27相关联。对于男性AS患者更需要重视OT及OP的诊断与防治。