rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2022-487-494rsp-3204Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHПатологические фенотипы состава тела у больных ревматическими заболеваниямиPathological phenotypes of body composition in patients with rheumatic diseaseshttps://orcid.org/0000-0002-8155-6101СорокинаА. О.SorokinaA. O.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0003-0961-9785ДеминН. В.DeminN. V.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-2809-0197ДобровольскаяО. В.DobrovolskayaO. V.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

olgavdobr@mail.ruhttps://orcid.org/0000-0001-6759-8367НикитинскаяО. А.NikitinskayaO. A.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0003-4739-4302ТоропцоваН. В.ToroptsovaN. V.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-7661-3124ФеклистовА. Ю.FeklistovA. Yu.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation202207092022604487494Copyright © Сорокина А.О., Демин Н.В., Добровольская О.В., Никитинская О.А., Торопцова Н.В., Феклистов А.Ю., 20222022Сорокина А.О., Демин Н.В., Добровольская О.В., Никитинская О.А., Торопцова Н.В., Феклистов А.Ю.Sorokina A.O., Demin N.V., Dobrovolskaya O.V., Nikitinskaya O.A., Toroptsova N.V., Feklistov A.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3204

Цель исследования – установить частоту изолированных и комбинированных патологических фенотипов состава тела у женщин с ревматическими заболеваниями (РЗ) и определить факторы, ассоциированные с саркопеническим фенотипом.

Материал и методы

Материал и методы. В исследование включены 255 женщин (медиана возраста – 60 [54; 64] лет), в том числе 114 – с ревматоидным артритом (РА), 46 – с системной склеродермией (ССД), 56 – с остеоартритом (ОА), 39 – без РЗ (контроль). Проведены анкетирование, антропометрические измерения, двухэнергетическая рентгеновская абсорбциометрия всего тела, поясничного отдела позвоночника и проксимального отдела бедра (шейка бедра, общий показатель). Оценка факторов, связанных с наличием саркопенического фенотипа, проводилась с помощью однофакторного регрессионного анализа.

Результаты

Результаты. Частота изолированных и комбинированных патологических фенотипов при ССД составила 34,8 и 52,2%, при РА – 51,8 и 38,6%, при ОА – 71,4 и 10,7% соответственно. Саркопенический фенотип при ССД и РА выявлялся чаще, чем при ОА (соответственно в 43,5, 29,8 и 1,8% случаев; р<0,001). Факторами, ассоциированными с наличием саркопенического фенотипа, являлись индекс массы тела (ИМТ) ><25 кг/м2 (отношение шансов (ОШ) – 7,89; 95%-й доверительный интервал (95% ДИ): 3,90–15,96; p><0,001), прием глюкокортикоидов (ГК) (ОШ=2,50; 95% ДИ: 1,32–4,73; p=0,005), кумулятивная доза ГК (ОШ=1,04; 95% ДИ: 1,01–1,07; p=0,008), наличие остеопороза (ОШ=4,31; 95% ДИ: 2,33–7,97; p><0,001), количество лейкоцитов больше 9,0×109 /л (ОШ=4,08; 95% ДИ: 1,38–12,10; p=0,011), содержание общего белка менее 65 г/л (ОШ=1,11; 95% ДИ: 1,02–1,19; p=0,019) и потребление кальция с продуктами питания менее 500 мг/сут. (ОШ=2,78; 95% ДИ: 1,39–5,53; p=0,004). Заключение. Проведенное исследование продемонстрировало значительную частоту патологических фенотипов состава тела у женщин с РЗ, при этом комбинированные фенотипы при ССД и РА встречались чаще, чем при ОА. Вероятность наличия саркопенического фенотипа повышалась при ИМТ><25 кг/м2 , приеме ГК и увеличении их кумулятивной дозы, наличии остеопороза и недостаточном потреблении кальция с продуктами питания. Ключевые слова: ревматические заболевания, состав тела, фенотипы состава тела, саркопения, остеопороз, остеосаркопения, ожирение, ревматоидный артрит, системная склеродермия, остеоартрит, факторы риска>˂ 0,001). Факторами, ассоциированными с наличием саркопенического фенотипа, являлись индекс массы тела (ИМТ)˂ 25 кг/м2 (отношение шансов (ОШ) – 7,89; 95%-й доверительный интервал (95% ДИ): 3,90–15,96; p<0,001), прием глюкокортикоидов (ГК) (ОШ=2,50; 95% ДИ: 1,32–4,73; p=0,005), кумулятивная доза ГК (ОШ=1,04; 95% ДИ: 1,01–1,07; p=0,008), наличие остеопороза (ОШ=4,31; 95% ДИ: 2,33–7,97; p><0,001), количество лейкоцитов больше 9,0×109 /л (ОШ=4,08; 95% ДИ: 1,38–12,10; p=0,011), содержание общего белка менее 65 г/л (ОШ=1,11; 95% ДИ: 1,02–1,19; p=0,019) и потребление кальция с продуктами питания менее 500 мг/сут. (ОШ=2,78; 95% ДИ: 1,39–5,53; p=0,004). >˂ 0,001), прием глюкокортикоидов (ГК) (ОШ=2,50; 95% ДИ: 1,32–4,73; p=0,005), кумулятивная доза ГК (ОШ=1,04; 95% ДИ: 1,01–1,07; p=0,008), наличие остеопороза (ОШ=4,31; 95% ДИ: 2,33–7,97; p<0,001), количество лейкоцитов больше 9,0×109 /л (ОШ=4,08; 95% ДИ: 1,38–12,10; p=0,011), содержание общего белка менее 65 г/л (ОШ=1,11; 95% ДИ: 1,02–1,19; p=0,019) и потребление кальция с продуктами питания менее 500 мг/сут. (ОШ=2,78; 95% ДИ: 1,39–5,53; p=0,004).

Заключение

Заключение. Проведенное исследование продемонстрировало значительную частоту патологических фенотипов состава тела у женщин с РЗ, при этом комбинированные фенотипы при ССД и РА встречались чаще, чем при ОА. Вероятность наличия саркопенического фенотипа повышалась при ИМТ<25 кг/м2 , приеме ГК и увеличении их кумулятивной дозы, наличии остеопороза и недостаточном потреблении кальция с продуктами питания. Ключевые слова: ревматические заболевания, состав тела, фенотипы состава тела, саркопения, остеопороз, остеосаркопения, ожирение, ревматоидный артрит, системная склеродермия, остеоартрит, факторы риска>˂ 25 кг/м2 , приеме ГК и увеличении их кумулятивной дозы, наличии остеопороза и недостаточном потреблении кальция с продуктами питания. 

Aim – to identify the frequency of isolated and combined pathological phenotypes of body composition in women with rheumatic diseases and to determine the factors associated with the sarcopenic phenotype.

Materials and methods

Materials and methods. 255 women (median age 60 [54; 64] years) were included in the study: 114 patients with rheumatoid arthritis (RA), 46 – with systemic sclerosis (SSc), 56 – with osteoarthritis (OA), and 39 persons without rheumatic diseases (control). Questionnaires, anthropometric measurements, double-energy X-ray absorptiometry of the whole body, lumbar spine and proximal femur were performed. The assessment of the factors associated with the sarcopenic phenotype was carried out using a univariate regression analysis.

Results

Results. The frequency of isolated and combined pathological phenotypes in women with SSc was 34.8% and 52.2%, with RA – 51.8% and 38.6%, with OA – 71.4% and 10.7%, respectively. The sarcopenic phenotype was more often determined in patients with SSc (43.5%) and RA (29.8%) compared with women with OA (1.8%) (p<0.001). The factors associated with the sarcopenic phenotype were BMI><25 kg/m2 (OR=7.89 [95% CI: 3.90–15.96]; p><0.001), glucocorticoids (GC) intake (OR=2.50 [95% CI: 1.32–4.73]; p=0.005) and cumulative GC dose (OR=1.04 [95% CI: 1.01–1.07]; p=0.008), presence of osteoporosis (OP) (OR=4.31 [95% CI: 2.33–7.97]; p><0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004). Conclusion. The study demonstrated a significant frequency of pathological phenotypes of body composition in women with rheumatic diseases, while combined phenotypes were more common in patients with SSc and RA compared with patients with OA. The probability of sarcopenic phenotype increased with BMI><25 kg/m2 , GC using, the presence of OP and insufficiency of calcium intake. Key words: rheumatic diseases, body composition phenotypes, sarcopenia, osteoporosis, osteosarcopenia, overfat, rheumatoid arthritis, systemic scleroderma, osteoarthritis, risk factors>˂ 0.001). The factors associated with the sarcopenic phenotype were BMI<25 kg/m2 (OR=7.89 [95% CI: 3.90–15.96];>˂ 25 kg/m2 (OR=7.89 [95% CI: 3.90–15.96]; p<0.001), glucocorticoids (GC) intake (OR=2.50 [95% CI: 1.32–4.73]; p=0.005) and cumulative GC dose (OR=1.04 [95% CI: 1.01–1.07]; p=0.008), presence of osteoporosis (OP) (OR=4.31 [95% CI: 2.33–7.97]; p><0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004). Conclusion. The study demonstrated a significant frequency of pathological phenotypes of body composition in women with rheumatic diseases, while combined phenotypes were more common in patients with SSc and RA compared with patients with OA. The probability of sarcopenic phenotype increased with BMI><25 kg/m2 , GC using, the presence of OP and insufficiency of calcium intake. Key words: rheumatic diseases, body composition phenotypes, sarcopenia, osteoporosis, osteosarcopenia, overfat, rheumatoid arthritis, systemic scleroderma, osteoarthritis, risk factors>˂ 0.001), glucocorticoids (GC) intake (OR=2.50 [95% CI: 1.32–4.73]; p=0.005) and cumulative GC dose (OR=1.04 [95% CI: 1.01–1.07]; p=0.008), presence of osteoporosis (OP) (OR=4.31 [95% CI: 2.33–7.97]; p<0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004).>˂ 0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004).

Conclusion

Conclusion. The study demonstrated a significant frequency of pathological phenotypes of body composition in women with rheumatic diseases, while combined phenotypes were more common in patients with SSc and RA compared with patients with OA. The probability of sarcopenic phenotype increased with BMI<25 kg/m2 , GC using, the presence of OP and insufficiency of calcium intake. Key words: rheumatic diseases, body composition phenotypes, sarcopenia, osteoporosis, osteosarcopenia, overfat, rheumatoid arthritis, systemic scleroderma, osteoarthritis, risk factors>˂ 25 kg/m2, GC using, the presence of OP and insufficiency of calcium intake. 

ревматические заболеваниясостав телафенотипы состава теласаркопенияостеопорозостеосаркопенияожирениеревматоидный артритсистемная склеродермияостеоартритфакторы рискаrheumatic diseasesbody composition phenotypessarcopeniaosteoporosisosteosarcopeniaoverfatrheumatoid arthritissystemic sclerodermaosteoarthritisrisk factorsСтатья подготовлена в рамках научно-исследовательской работы ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой». Государственное задание № 1021051403074-2.ReferencesBraun T, Schett G. Pathways for bone loss in inflammatory disease. Curr Osteoporos Rep. 2012;10(2):101-108. doi: 10.1007/s11914-012-0104-5Braun T, Schett G. Pathways for bone loss in inflammatory disease. Curr Osteoporos Rep. 2012;10(2):101-108. doi: 10.1007/s11914-012-0104-5Güler-Yüksel M, Hoes JN, Bultink IEM, Lems WF. Glucocorticoids, inflammation and bone. Calcif Tissue Int. 2018;102(5):592-606. doi: 10.1007/s00223-017-0335-7Güler-Yüksel M, Hoes JN, Bultink IEM, Lems WF. 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The authors declare that there are no conflicts of interest present.