强直性脊柱炎患者的骨密度随治疗药物的变化。

The change of bone mineral density according to treatment agents in patients with ankylosing spondylitis.

机构信息

Division of Rheumatology, Department of Internal Medicine, Medical College, Chungbuk National University, Cheongju, South Korea.

出版信息

Joint Bone Spine. 2011 Mar;78(2):188-93. doi: 10.1016/j.jbspin.2010.05.010.

DOI:10.1016/j.jbspin.2010.05.010

PMID:20621536

Abstract

OBJECTIVES

The aim was to access the effects of treatment on bone mineral density (BMD) by treatment agents in patients with ankylosing spondylitis (AS).

METHODS

We analyzed clinical characteristics of 90 AS patients. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and x-ray of lumbar spine (L-spine) and sacroiliac joint were included in the baseline assessment. The BMDs of right femur and L-spine were measured annually using dual x-ray absorptiometry (DXA). The patients were divided into one of the following four groups by agents exposed for the follow-up period: conventional treatment, bisphosphonate, anti-TNF-α agent or bisphosphonate + anti-TNF-α agent. We evaluated the changes of BMD according to treatment groups.

RESULTS

The average age of disease onset was 30 years and the mean disease duration was 8.2 years. The patients who were assigned to the groups of conventional treatment, bisphosphonate, anti-TNF-α agents and bisphosphonate + anti-TNF-α agents were 40, 20, 19 and 11. BMDs values of both L-spine and femur showed tendencies to the most increase in the group treated with concurrent bisphosphonate and anti-TNF-α agent. However, the change of BMD by treatment agents was significant different only in trochanter (P = 0.001). In patients without syndesmophyte, there was significant difference of BMD change in both L-spine and total proximal femur (P = 0.001, 0.004). The BMD change of trochanter was correlated with the reductions of ESR and CRP (r = 0.239, P = 0.035 and r = 0.233, P = 0.040).

CONCLUSIONS

The BMDs of AS patients increased more by the treatment of concurrent bisphosphonate and anti-TNF-α agents. The gain of bone mass was associated with the reduction of inflammation.

摘要

目的

评估治疗强直性脊柱炎（AS）患者的不同药物对骨密度（BMD）的影响。

方法

我们分析了 90 例 AS 患者的临床特征。基线评估包括红细胞沉降率（ESR）、C 反应蛋白（CRP）、腰椎（L 脊柱）和骶髂关节 X 光检查。每年使用双能 X 线吸收仪（DXA）测量右股骨和 L 脊柱的 BMD。根据随访期间暴露的药物将患者分为以下四组之一：常规治疗组、双膦酸盐组、抗 TNF-α 药物组或双膦酸盐+抗 TNF-α 药物组。我们根据治疗组评估 BMD 的变化。

结果

发病年龄平均为 30 岁，病程平均为 8.2 年。被分配到常规治疗、双膦酸盐、抗 TNF-α 药物和双膦酸盐+抗 TNF-α 药物组的患者分别为 40、20、19 和 11 人。L 脊柱和股骨的 BMD 值均显示出同时使用双膦酸盐和抗 TNF-α 药物治疗的患者增加最多的趋势。然而，只有在转子间区（P = 0.001），治疗药物对 BMD 的影响才有显著差异。在没有脊柱融合的患者中，L 脊柱和总近端股骨的 BMD 变化有显著差异（P = 0.001，0.004）。转子间区 BMD 变化与 ESR 和 CRP 的降低相关（r = 0.239，P = 0.035 和 r = 0.233，P = 0.040）。