【摘要】 研究强直性脊柱炎(AS)骨质疏松和骨量减少的发生情况、相关因素及与骨代谢指标的关系。选97例AS患者作为观察组,分别检测其血沉(ESR)、C反应蛋白(CRP)、HLAB27、血钙(Ca)、血磷(P)、碱性磷酸酶(ALP),并进行全身疼痛评分、中医症状积分评定和晨僵时间、BATH功能指数(BASFI)、病情活动指数(BASDI)、颌柄距、指地距、枕墙距、Schober试验、胸阔活动度、脊柱活动度;用双能X线法(DEXA)测定腰椎、股骨颈、股骨转子部、Ward’s三角区骨密度(BMD),检测骨钙素(BGP)、降钙素(HCT)、甲状旁腺激素(PTH);42例检测了尿脱氧吡啶啉(DPyr)。选102名健康人作为对照组,分别测定其腰椎、股骨颈、股骨转子部、Ward’s三角区骨密度(BMD),31例检测了BGP、PTH、DPyr、Ca、P、ALP。结果AS患者发生骨质疏松者42例(42.27%),骨量减少者36例(37.11%);AS患者BGP较对照组显著降低,并与腰椎、股骨近端BMD呈正相关。PTH、尿DPyr较对照组显著增高,并与股骨近端BMD呈负相关。AS患者中急时相反应物ESR与腰椎、股骨近端BMD呈显著负相关,CRP与AS患者腰椎、股骨颈、三角BMD呈显著负相关,ESR、CRP与尿DPyr呈显著的正相关。腰椎BMD与全身疼痛评分、中轴关节压痛指数呈负相关性,股骨近端BMD与指地距、BASFI、BASDAI呈显著负相关,与Schober试验、脊柱活动度呈显著正相关。AS患者的腰椎BMD与HLAB27显示了负相关性。表明骨质疏松或骨量减少在AS中普遍存在,其发生与遗传、废用、免疫炎症等因素相关。AS患者骨代谢的失衡以骨生成的减少、骨吸收的增加为特点;PTH的增高及免疫炎性反应与AS患者骨吸收的增加有关。更多还原

【Abstract】 The objective of the paper is to study the occurrence and related factors of osteoporosis and bone decrease in ankylosing spondylitis (AS) and the relationship between them and the bone metabolic indices. Ninety-seven cases of AS and 102 healthy persons were selected as the observed group and the control group, respectively; the observed items of the observed group included: ESR, CRP, HLA-B27, Ca, P, ALP, PTH, BGP detected by ELISA, whole-body-painful and TCM-symptomatic-integral scorings, morning stiffness time, Bath AS function index (BASFI), Bath AS disease activity index (BASDAI), distances from jaw to presternum, from finger to ground and from occipital bone to wall, Schober test, chest expansion, spinal activity, BMD in the lumbar vertebrae, femoral neck and Ward’s triangle detected by DEXA for all the cases, 42 of them received D-Pyr besides, and the ones of the control group included: BMD in the lumbar vertebrae, femoral neck, femoral trochanter and Ward’s triangle for all the cases, 31 of them received BGP, PTH, D-Pyr Ca, P and ALP besides. The results showed: ① 97 AS cases included 42 of osteoporosis with 42.27 % and 36 of bone decrease with 37.11 %; ② BGP in AS were significantly reduced in comparison with the control group and positively correlated to BMD in the lumbar vertebrae and proximal femur; ③ PTH and D-Pyr in AS were significantly increased and negatively correlated to BMD in the proximal femur; ④ ESR was significantly negatively correlated to BMD in the lumbar vertebrae and proximal femur and so was CRP to BMD in the lumbar vertebrae, femoral neck and Ward’s triangle; ⑤ ESR and CRP were significantly positively correlated to D-Hyr; ⑥ BMD in the proximal femur was correlated significantly negatively to the distance from finger to ground, BASFI and BASDAI but significantly positively to Schober test and the spinal activity; ⑦ BMD in the lumbar vertebrae was negatively correlated to the whole-body painful and axial-joint-tenderness index and HLA-B27, suggesting that osteoporosis or bone loss is very popular, which was related to some factors, such as heredity, disuse, immune inflammations, etc; the bone-metabolic imbalance in AS is characterized by osteogenesis decrease and bone absorption increase; the PTH increase and immune inflammatory reactions are related to the bone absorption increase in AS.更多还原