类风湿关节炎患者血糖、血脂水平与骨密度的关系
| 作者: |
1阮圣霆,
1夏光云,
1汪珊
1 合肥市滨湖医院风湿免疫科，合肥 230061 |
| 通讯: |
阮圣霆
Email: rrssttaa@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2021.08.008 |
摘要
目的：探究类风湿关节炎(rheumatoid arthritis，RA)患者血糖、血脂水平与骨密度的关系。方法：选择2017年12月至2020年12月合肥市滨湖医院收治的RA患者60例作为RA组，并选择同期健康体检患者60例作为对照组，比较两组患者L1~L4以及两侧股骨颈的骨密度(bone mineral density，BMD)及血糖[空腹血糖(fasting blood-glucose，FBG)、糖化血红蛋白(hemoglobin A1c，HbAlc)]、血脂[三酰甘油(triglyceride，TG)、总胆固醇(total cholesterol，TC)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol，LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol，HDL-C)]水平。根据BMD将RA组患者分成骨量正常组(n=27)、骨量减少组(n=21)、骨质疏松(OP)组(n=12)，比较3组患者的血糖、血脂水平，并探究BMD水平与血糖、血脂水平的关系。结果：RA组的FBG、HbAlc、TC、TG、LDL-C水平均高于对照组，差异有统计学意义(P<0.05)；HDL-C水平低于对照组，差异有统计学意义(P<0.05)；RA组的L1~L4及股骨颈BMD低于对照组，差异有统计学意义(P<0.05)；RA组的OP发生率为21.67%，高于对照组的8.33%；RA组中不同骨代谢水平的FBG、HbAlc、TC、TG、LDL-C、HDL-C水平比较，组间差异有统计学意义(P<0.05)；OP组的FBG、HbAlc、TC、TG、LDL-C均高于骨量正常组及骨量减少组，差异有统计学意义(P<0.05)，HDL-C水平均低于骨量正常组及骨量减少组，差异有统计学意义(P<0.05)；L1~L4及股骨颈的BMD与FBG、HbAlc、TC、TG、LDL-C均呈负相关(P<0.05)，L1~L4及股骨颈的BMD与HDL-C水平呈正相关(P<0.05)。结论：RA患者的血脂、血糖水平较健康人紊乱，BMD水平低于健康人，OP发生率较健康人高，OP发生与血糖、血脂代谢的紊乱相关，因此预防RA发生血糖、血脂代谢紊乱对减少OP发生有重要意义。
关键词：
类风湿关节炎；脂代谢；糖代谢；骨密度；骨质疏松
Relationship between blood glucose, blood lipid levels and bone mineral density in patients with rheumatoid arthritis
CorrespondingAuthor: RUAN Shengting Email: rrssttaa@163.com
DOI: 10.3978/j.issn.2095-6959.2021.08.008
Abstract
Objective: To explore the relationship between blood glucose, blood lipid levels and bone mineral density (BMD) in patients with rheumatoid arthritis (RA). Methods: Sixty RA patients admitted from December 2017 to December 2020 were enrolled as a RA group, while other 60 healthy controls during the same period were enrolled as a control group. BMD of L1–L4 lumbar vertebrae and bilateral femoral necks, levels of blood glucose [fasting blood glucose (FBG), hemoglobin A1c (HbAlc)] and blood lipid [triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)] were compared between the 2 groups. According to different BMD, patients in RA group were divided into normal bone mass group (n=27), osteopenia group (n=21) and osteoporosis (OP) group (n=12). The levels of blood glucose and blood lipid among the three groups were compared. The relationship between BMD levels and blood glucose, blood lipid levels in RA group was explored. Results: The levels of FBG, HbAlc, TC, TG and LDL-C in RA group were higher than those in control group (P<0.05), while HDL-C level was lower than that in control group (P<0.05). BMD of L1–L4 lumbar vertebrae and femoral neck in RA group was lower than that in control group (P<0.05), while incidence of OP was higher than that in control group (21.67% vs 8.33%) (P<0.05). The differences in levels of FBG, HbAlc, TC, TG, LDL-C and HDL-C were statistically significant among patients with different bone metabolism level in RA group (P<0.05). FBG, HbAlc, TC, TG and LDL-C in OP group were higher than those in normal bone mass group and osteopenia group (P<0.05), while HDL-C level was lower than that in normal bone mass group and osteopenia group (P<0.05). BMD of L1–L4 lumbar vertebrae and femoral neck was negatively correlated with HbAlc, TC, TG and LDL-C (P<0.05), while positively correlated with HDL-C (P<0.05). Conclusion: Compared with the healthy people, RA patients showed more disordered levels of blood lipid and blood glucose, with lower BMD level and higher incidence of OP. The occurrence of OP is related to the disorders of blood glucose and blood lipid metabolism. Therefore, preventing the occurrence of glucose-lipid metabolism disorders is of great significance for reducing the incidence of OP.
Keywords：
rheumatoid arthritis; lipid metabolism; glucose metabolism; bone mineral density; osteoporosis