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目的探讨早期强直性脊柱炎(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。方法回顾性研究调查2006年3月至2014年12月中日友好医院中医风湿病科确诊为早期AS患者120例,其中女性57例,平均年龄(31.02±5.94)岁;男性63岁,平均年龄(29.79±6.87)岁。健康人107例,其中女性48例,平均年龄(32.97±6.47)岁;男性59例,平均年龄(29.58±6.65)岁。双光能X线法检测腰椎、股骨颈、股骨粗隆的BMD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)早期AS男性患者各部位的BMD均较健康人减低(P<0.01),而女性患者则和健康人无统计学差异。(2)早期AS患者骨质疏松(osteoporosis,OP)6例(5%),骨量减少(osteopenia,OT)36例(21.67%)。其中男性早期AS患者腰椎OP者5例(7.93%),OT者29例(46.03%)。早期AS患者中,男性腰椎部位OP、OT发生率较女性高(P<0.05),股骨颈及股骨粗隆部位OP/OT发生率无差异。(3)中、低年龄组中,早期AS患者的腰椎和股骨颈BMD较健康人显著减低,差异有统计学差异(P<0.01)。(4)男性早期AS患者腰椎BMD与年龄呈显著负相关(P<0.01)。结论早期AS男性患者即可出现显著BMD下降,OP发生率为7.93%,OT发生率为46.03%。其中腰椎部位BMD减低及OT发生率更为突出。早期AS患者BMD的下降与疾病活动指标无关联。对于男性AS患者,在疾病早期即需要重视OT及OP的诊断与防治。
Objective To investigate the relationship between bone mineral density (BMD) and BMD in patients with early ankylosing spondylitis (AS) and other clinical features. Methods A retrospective study was conducted to investigate the clinical data of 120 patients diagnosed as early stage AS in rheumatology department of Sino-Japanese Friendship Hospital from March 2006 to December 2014. Among them, 57 were female, with an average age of (31.02 ± 5.94) years; male, 63 years, mean age (29.79 ± 6.87) years old. There were 107 healthy people, including 48 females, with an average age of (32.97 ± 6.47) years and 59 males (mean age, 29.58 ± 6.65 years). Dual light X-ray method was used to detect the BMD of lumbar vertebrae, femoral neck and femoral trochanter with age, course of disease, disease activity index and imaging index. Results (1) The BMD of various parts of early AS male patients was lower than that of healthy people (P <0.01), while there was no significant difference between female patients and healthy people. (2) Osteoporosis (OP) in 6 cases (5%) and osteopenia (OT) in 36 cases (21.67%) of early AS patients. Among them, 5 cases (7.93%) had lumbar OP in men with early AS and 29 cases (46.03%) had OT. The incidence of OP and OT in lumbar spine was higher in male patients than in female patients (P <0.05). There was no difference in the incidence of OP / OT between femoral neck and femoral trochanter. (3) BMD of lumbar vertebral and femoral neck in early AS patients was significantly lower than that in healthy people in middle and low age groups, the difference was statistically significant (P <0.01). (4) The BMD of lumbar spine of male patients with early AS was negatively correlated with age (P <0.01). Conclusion Significant decrease of BMD can be observed in early AS male patients. The incidence of OP was 7.93% and the incidence of OT was 46.03%. Among them, the lumbar spine BMD is reduced and the incidence of OT is more prominent. The decline of BMD in patients with early AS was not associated with disease activity. For male patients with AS, early in the disease that need to pay attention to the diagnosis and prevention of OT and OP.