摘要

        目的：比较中轴型脊柱关节炎(axSpA)与正常匹配人群之间松质骨评分(TBS)的差异，同时明确与低TBS相关的风险因素。

        方法：采用双能X线吸收法评估两组间TBS和骨密度(BMD)。同时评估骨质疏松的危险因素和炎性指标。评估axSpA组患者骶髂关节和脊柱的疾病活动度以及影像学进展。多元线性回归分析明确与低TBS相关的风险因素。

        结果：在axSpA组，共纳入了248例患者;同时在对照组纳入了同等数目以及年龄和性别相匹配的正常人群。对照组和axSpA组TBS评分分别为1.43和1.38(P < 0.001)。两组间腰椎BMD检查未见明显异常。TBS评分仅与axSpA患者的ESR、CRP成负相关。axSpA组韧带骨化与低TBS相关，但腰椎BMD水平高于对照组。多因素分析显示ESR、CRP和脊柱影像学进展与TBS显著相关。

        结论：TBS评估显示与对照组人群相比，axSPA患者骨质量相对更差。在axSPA患者中，系统性炎性指标与TBS和脊柱影像学进展呈负相关，炎性指标与低TBS之间独立相关。因此，TBS有可能是一个有用的临床工具用于评估axSpA患者骨质疏松发生的风险。

        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.