河北医科大学学报 ›› 2025, Vol. 46 ›› Issue (8): 959-964.doi: 10.3969/j.issn.1007-3205.2025.08.015

• • 上一篇    下一篇

不同严重程度类风湿关节炎患者骨密度及骨代谢指标水平与肌少症的相关性分析

  

  1. 1.四川省成都市第三人民医院风湿免疫科及疑难罕见病中心，四川  成都  610041；
    2.四川省成都市第三人民医院全科医学科，四川  成都  610041

  • 出版日期:2025-08-25 发布日期:2025-08-29
  • 作者简介:李芳（1987-），女，四川眉山人，四川省成都市第三人民医院主治医师，医学硕士，从事类风湿关节炎疾病诊治研究。

  • 基金资助:
    四川省医学科技创新研究会科学研究项目（YCH-KY-YCZD2024-257）

Correlation analysis of bone mineral density and bone metabolism index levels with sarcopenia in patients with rheumatoid arthritis of different severity

  1. 1.Department of Rheumatology and Immunology and Center for Difficult and Rare Diseases, 
    the Third People′s Hospital of Chengdu, Sichuan Province, Chengdu 610041, China; 
    2.Department of General Practice, the Third People′s Hospital of Chengdu, 
    Sichuan Province, Chengdu 610041, China

  • Online:2025-08-25 Published:2025-08-29

HTML

PDF (PC)

2

摘要： 目的 探析骨密度与骨代谢指标与不同疾病活动度类风湿关节炎（rheumatoid arthritis，RA）患者肌少症的相关性，为临床提供一定的理论依据。
方法 选取2021年12月—2024年12月于四川省成都市第三人民医院就诊的97例RA患者，根据是否发生肌少症分为研究组与对照组，同时记录患者的部分炎症指标、骨密度及骨代谢指标，并根据DAS28评分评定不同严重程度的RA（轻度活动度、中度活动度、重度活动度）。
结果 轻度、中度、重度活动度RA组肌少症的患病率分别为42.86%、62.22%、80.64%，差异有统计学意义（P＜0.001）；相关性分析显示，除肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）、白细胞介素6（interleukin-6，IL-6）与肌少症呈正相关（r=0.381、0.615，P＜0.001）外，腰椎骨密度（T12~L2）、血清骨碱性磷酸酶（bone alkaline phosphatase，BALP）、β-胶原特殊序列（beta-C-terminal telopeptide of type I collagen，β-CTX）、Ⅰ型前胶原氨基端前肽（procollagen type Ⅰ N-terminal propeptide，PINP）、N端骨钙素（N-terminal osteocalcin，N-MID）、25-羟基维生素D3［25（OH）D3］、甲状旁腺素（parathyroid hormone，PTH）皆呈负相关（r=-0.711、-0.370、-0.359、-0.717、-0.622、-0.554、-0.708，P＜0.001）；有序Logistics回归分析显示，β-ALP、25（OH）D3、 PTH是不同疾病活动度RA患者发生肌少症的保护因素（OR=0.488、0.776、0.115）；联合指标预测RA患者发生肌少症的ROC曲线下面积为0.984，敏感度与特异度分别为0.920、0.946。
结论 在轻、中、重度类风湿关节炎患者中，T12~L2、β-ALP、25（OH）D3及PTH下降越明显，肌少症发生风险越高；β-ALP、25（OH）D3、PTH为保护因素，联合检测对RA患者肌少症有较高预测价值。


关键词: 类风湿关节炎, 肌少症, 骨密度

Abstract: Objective To explore the correlation between bone mineral density (BMD), bone metabolism indexes and sarcopenia in patients with rheumatoid arthritis (RA) of different disease activity, so as to provide a theoretical basis for clinical practice. 
Methods A total of 97 RA patients who were treated in the Third People′s Hospital of Chengdu from December 2021 to December 2024 were selected and divided into the research group and the control group according to the occurrence of sarcopenia. Some inflammatory indexes, BMD and bone metabolism indexes of the patients were recorded. The RA of different severity (mild activity, moderate activity, severe activity) was evaluated according to DAS28 score. 
Results The prevalence rates of sarcopenia in RA patients with mild, moderate and severe activity were 42.86%, 62.22% and 80.64% respectively, with significant differences (P＜0.001). Correlation analysis showed that tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were positively correlated with sarcopenia (r=0.381, 0.615, P＜0.001), while lumbar BMD (T12-L2), serum bone alkaline phosphatase (BALP), β-C-terminal telopeptide of type I collagen (β-CTX), procollagen type Ⅰ N-terminal propeptide (PINP), N-terminal osteocalcin (N-MID), 25-hydroxyvitamin D3 ［25(OH)D3］ and parathyroid hormone (PTH) were negatively correlated with sarcopenia (r=-0.711, -0.370, -0.359, -0.717, -0.622, -0.554, -0.708, P＜0.001). Ordered logistics regression analysis showed that β-ALP, 25(OH)D3 and PTH were protective factors for sarcopenia in RA patients with different disease activity (OR=0.488, 0.776, 0.115). The area under the receiver operating characteristic (ROC) curve of combined indexes for predicting sarcopenia in RA patients was 0.984, with sensitivity and specificity of 0.920 and 0.946 respectively. 
Conclusion In patients with mild, moderate and severe rheumatoid arthritis, the more obvious the decrease of T12-L2, β-ALP, 25(OH)D3 and PTH, the higher the risk of sarcopenia. β-ALP, 25(OH)D3 and PTH are protective factors, and their combined detection has high predictive value for sarcopenia in RA patients. 

Key words: rheumatoid arthritis, sarcopenia, bone mineral density

版权所有 © 《河北医科大学学报》编辑部
本系统由北京玛格泰克科技发展有限公司设计开发