肌少症与女性类风湿性关节炎病人病情及继发骨质疏松的相关性研究

张梅; 徐胜前; 纵何香; 王健雄; 储依然; 张璟; 蔡静玉; 常玲

doi:10.13898/j.cnki.issn.1000-2200.2024.01.016

肌少症与女性类风湿性关节炎病人病情及继发骨质疏松的相关性研究

Study on the correlation between sarcopenia and disease activity and secondary OP in female RA patients

摘要

摘要:
目的探讨肌少症对女性类风湿关节炎（RA）病人病情以及继发骨质疏松（OP）的影响。
方法选取239例RA病人，其中女187例，男52例。通过生物电阻抗分析法测定病人四肢以及躯干的骨骼肌质量，计算骨骼肌质量指数（SMI）。采用GE Lunar Prodigy双能X线骨密度仪，测量病人不同部位的骨密度（BMD）。对187例女性RA病人进行疾病相关指标如双手X线、Sharp评分检测，并根据是否存在肌少症，将女性RA病人分为肌少症组和无肌少症组，比较2组OP发生率、疾病活动性以及关节功能相关指标，分析女性RA病人发生OP的影响因素。
结果女性RA病人总OP发生率明显高于男性RA病人（P＜0.01）。与无肌少症的女性RA病人相比，合并肌少症的女性RA病人病程更长，体质量指数更低，关节结构损害更严重（P＜0.05~P＜0.01）。女性RA病人SMI与病程、年龄、健康评估问卷（HAQ）评分、X线分期、Sharp评分均呈负相关关系（r=-0.155、-0.196、-2.040、-0.244、-0.365，P＜0.05~P＜0.01），与股骨颈-BMD、L₁-BMD、L₂-BMD、L₃-BMD、L₄-BMD、L_1~4-BMD均呈明显正相关关系（r=0.422、0.410、0.380、0.423、0.434、0.437，P＜0.01）。多元回归分析结果显示，SMI值是女性RA病人发生OP的保护因素（P＜0.01），年龄是女性RA病人发生OP的危险因素（P＜0.01）；病程、HAQ评分是女性RA病人DAS28的影响因素（P＜0.05和P＜0.01）。
结论女性RA病人更容易合并OP，肌少症是OP的危险因素，且与女性RA病人的关节结构损伤密切相关。

Abstract:
ObjectiveTo investigate the effect of sarcopenia on the disease activity and secondary osteoporosis (OP) in female patients with rheumatoid arthritis (RA).
MethodsA total of 239 RA patients were selected, including 187 females and 52 males.The skeletal muscle mass of the patient's limbs and trunk was measured by the bioelectrical impedance analysis, and the skeletal muscle mass index (SMI) was calculated.The GE Lunar Prodigy dual energy X-ray absorptiometry was used to measure the bone mineral density (BMD) of different parts of the patients.In addition, 187 female RA patients were tested for disease-related indicators such as hand X-ray and Sharp score, and divided into sarcopenia group and non-sarcopenia group.The incidence of OP, disease activity and joint function were compared between the two groups, and the influencing factors of OP in female RA patients were analyzed.
ResultsThe incidence of total OP in female RA patients was significantly higher than that in male RA patients (P < 0.01).Compared with female RA patients without sarcopenia, female RA patients with sarcopenia had a longer disease course, lower body mass index, and more severe joint structure damage (P < 0.05 to P < 0.01).The SMI of female RA patients was negatively correlated with disease course, age, health assessment questionnaire (HAQ) score, X-ray stage and Sharp score (r=-0.155, -0.196, -2.040, -0.244, -0.365, P < 0.05 to P < 0.01), and significantly positively correlated with femoral neck-BMD, L₁-BMD, L₂-BMD, L₃-BMD, L₄-BMD and L_1-4-BMD (r=0.422, 0.410, 0.380, 0.423, 0.434, 0.437, P < 0.01).The results of multiple regression analysis showed that SMI value was a protective factor for OP in female RA patients (P < 0.01), age was a risk factor for OP in female RA patients (P < 0.01);disease course and HAQ score were the influencing factors of DAS28 in female RA patients (P < 0.05 and P < 0.01).
ConclusionsFemale RA patients are more likely to be complicated with OP.Sarcopenia is a risk factor for OP and is closely related to the joint structure damage in female RA patients.

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