摘要
目的：比較中軸型脊柱關節炎(axSpA)與正常匹配人群之間鬆質骨評分(TBS)的差異，同時明確與低TBS相關的風險因素。
方法：采用雙能X線吸收法評估兩組間TBS和骨密度(BMD)。同時評估骨質疏鬆的危險因素和炎性指標。評估axSpA組患者骶髂關節和脊柱的疾病活動度以及影像學進展。多元線性回歸分析明確與低TBS相關的風險因素。
結果：在axSpA組，共納入了248例患者;同時在對照組納入了同等數目以及年齡和性別相匹配的正常人群。對照組和axSpA組TBS評分分別為1.43和1.38(P < 0.001)。兩組間腰椎BMD檢查未見明顯異常。TBS評分僅與axSpA患者的ESR、CRP成負相關。axSpA組韌帶骨化與低TBS相關，但腰椎BMD水平高於對照組。多因素分析顯示ESR、CRP和脊柱影像學進展與TBS顯著相關。
結論：TBS評估顯示與對照組人群相比，axSPA患者骨質量相對更差。在axSPA患者中，係統性炎性指標與TBS和脊柱影像學進展呈負相關，炎性指標與低TBS之間獨立相關。因此，TBS有可能是一個有用的臨床工具用於評估axSpA患者骨質疏鬆發生的風險。
附原文：
Objectives:To compare the trabecular bone score (TBS) between patients with axial spondyloarthritis (axSpA) and matched normal controls and identify risk factors associated with a low TBS.
Methods:TBS and BMD were assessed in the two groups (axSpA and control) using DXA. Osteoporosis risk factors and inflammatory markers were also assessed. Disease activity and radiographic progression in the sacroiliac joint and spinewere evaluated in the axSpA group. Multivariate linear regression analysis was performed to identify risk factors associated with TBS.
Results:In the axSpA group, 248 subjects were enrolled; an equalnumber of age- and sex-matched subjects comprised the control group. The mean TBS was 1.43 (0.08) and 1.38 (0.12) in the control and axSpA groups, respectively (P < 0.001); BMD at the lumbar spine did not differ between the two groups. The TBS was negatively correlated with ESR and CRP levels in the axSpA group only (P < 0.001 and P = 0.007,respectively). Syndesmophytes in the axSpA group was associated with lower TBS(P < 0.001) but higher lumbar BMD (P = 0.021) vs controls. In the multivariate analyses, ESR, CRP and spinal radiographic progression were significantly associated with TBS.
Conclusion:TBS assessments revealed poor bone quality in patients with axSpA compared with the matched controls. In axSpA, systemic inflammatory markers were negatively correlated with TBS and spinal radiographic progression and inflammatory markers were independently correlated with low TBS. TBS may, therefore, be a useful clinical tool to identify the risk of osteoporosis in patients with axSpA.
引自：Kang KY,Goo HY,Park SH,HongYS.Trabecular bone score as an assessment tool toidentify the risk of osteoporosis in axial spondyloarthritis: a case-controlstudy.Rheumatology (Oxford).2018 Mar 1; 57(3): 462-469. doi:10.1093/rheumatology/kex377.
