| ObjectiveTo analyze the risk factors influenced the bone mineral density(bone mineral density,BMD)of ankylosing spondylitis(ankylosing spondylitis,AS)patients and their clinal significances.MethodRandomly selecting 49 male patients diagnosed AS from April 2017 to April 2018,Department of Rheumatology &Immunology of China-Japan Union hospital of Ji Lin university.The 49 cases of male patients met the AS diagnostic criteria revised by American college of rheumatology in 1984.Aging 20-55(median age 30 years old),course of disease 3-336 months(median duration of 60 months).All patients except Myelodysplastic syndrome and osteosarcoma,which may affect bone mineral density changes of the blood system diseases,all except for severe liver and kidney function damage,with the exception of hyperthyroidism,hyperparathyroidism,Cushing’s syndrome,and other endocrine disease may cause abnormal bone mass,and the use of sex hormones,glucocorticoids and other drugs affecting bone metabolism,except for systemic lupus erythematosus,rheumatoid arthritis,osteoarthritis and other rheumatic diseases cause abnormal bone mass,except for female patients.The patient’s medical history was inquired in detail,and the patient’s age,gender,weight,height,course of disease,and the incidence and progress of the affected joints were recorded.The rheumatologist and the patient jointly assessed the specific score according to the AS disease activity index(BASDAI)and AS patient function index(BASFI)scoring rules.Erythrocyte sedimentation rate(ESR)and c-reactive protein(CRP)were recorded.The positive and lateral radiographs of the cervical,thoracic and lumbar vertebrae as well as the positive and lateral radiographs of the sacroiliac joints of the patients were reviewed.The rheumatologists and radiologists jointly assessed whether there were ligament osteophytes in the X-ray radiographs of the cervical,thoracic and lumbar vertebrae of the patients,as well as the positive radiographs of the sacroiliac joints of the patients,then judged the grading of sacroiliac arthritis according to the grading criteria of sacroiliac arthritis.The BMD values and T values of lumbar spine(1-4),femoral neck,greater trochanter,total hip joint and Ward triangle were measured by dual-energy X-ray absorptiometry(DXA).The diagnostic criteria for osteoporosis were in accordance with the diagnostic criteria issued by the world health organization(WHO)in 1994.Correlation analysis was applied to obtain the influencing factors related to bone mineral density.Analyze the effects of the following variable items on the changes of bone mineral density in patients with ankylosing spondylitis by using the variables of age,disease course,whether the bone mass was normal or not,and the formation of ligament osteophyte or not as grouping,then make intra-group comparison,so as to provide a basis for clinical diagnosis and treatment.Using SPSS24.0 statistical software for data analysis,measurement data with ?±s or median(quartile)correlation test,Pearson correlation analysis and Spearman rank correlation analysis;For the difference test,the independent sample T test or the mann-whitney U test were applied,and P<0.05 was considered statistically significant.The Graphpad Prism 7.0 software was used for graph generation.Result(1)Lumbar BMD was positively correlated with age(P<0.05),course of disease(P<0.01),body weight(P<0.01),BASFI(P<0.01)and sacroiliac arthritis(P<0.05)in AS patients,while total hip BMD was negatively correlated with age(P<0.01)and course of disease(P<0.05),and positively correlated with body weight(P<0.01).BASFI and sacroiliac arthritis grading showed significant positive correlation with age and disease course(P<0.01).(2)According to the diagnostic criteria of osteoporosis,there were 20 cases(40.82%)with osteoporosis,19 cases(38.78%)with decreased bone mass and 10 cases(20.40%)with normal bone mass in the 49 patients with AS.There was no significant difference in age between patients in the group with abnormal bone mass and those in the group with normal bone mass(P>0.05).(3)There were 21 cases in the low age group(20~29 years old),21 cases in the middle age group(30~39 years old),and 7 cases in the high age group(40 years old or older).The BMD of lumbar vertebrae in the high age group was higher than that in the low age group(P<0.05),and the BMD of total hip joint in the high age group was lower than that in the middle age group(P<0.05)and the low age group(P<0.01).(4)BMD of lumbar vertebrae in the long course group was higher than that in the short course group(P<0.01),total hip joint BMD was lower than that in the short course group(P<0.05),BSAFI(P<0.01)and sacroiliac arthritis grading(P<0.01)were higher than that in the short course group.(5)Both lumbar BMD and total hip BMD increased with weight gain(P<0.01).Appropriate weight training and functional exercise can increase bone remodeling and bone mass.(6)The proportion of patients with abnormal bone mass of lumbar vertebra and total hip joint in the ligamentous osteophyte group was 29% and 46%,respectively.The proportion of patients with abnormal bone mass of lumbar vertebra and total hip joint in the ligamentous osteophyte group was 56% and 48%,respectively.The age(P<0.01),weight(P<0.05),course of disease(P<0.01)and lumbar BMD(P<0.01)of the ligament osteophyte group were all higher than those of the non-ligament osteophyte group.There was no significant difference in total hip BMD between the two groups(P>0.05).Conclusion1.AS patients at any age can appear abnormal bone mass.2.Advanced age,long course of disease and low body weight were risk factors for bone loss in AS patients;3.The reliability of BMD test results should be increased by selecting appropriate test sites or conducting multi-site tests according to the different disease course of patients. |
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