系统性红斑狼疮发生骨质疏松的相关危险因素分析

Risk factors of osteoporosis in patients with systemic lupus erythematosus

目的探讨系统性红斑狼疮患者发生骨质疏松的危险因素,为监测、预防和治疗系统性红斑狼疮患者骨质疏松提供依据。方法选取SLE患者合并骨量减少或骨质疏松的患者105例,其中女性96例,男性9例,性别构成、年龄、体重指数与之匹配的健康对照组55例。收集两组人口统计学信息、合并疾病、用药史、生化检查和骨密度测定的结果,男性和绝经后≥50岁的女性使用T值评分,男性和绝经前<50岁的女性使用Z值评分。通过logistic回归分析研究对象发生骨质疏松的危险因素。结果SLE组高脂血症、高血压、股骨头坏死、骨折史比例均高于HC组(P<0.05)。SLE组有糖皮质激素用药史103人,平均激素用量(11.1±10.1)mg/d。有免疫抑制剂用药史98人。SLE组血清C3、C4较HC组减低,差异有统计学意义(P<0.05)。骨代谢指标方面:SLE组血钙、25羟维生素D明显低于HC组,骨形成标志物骨钙素SLE组明显低于HC组,差异均有统计学意义(P<0.05)。骨吸收标志物PINP、β-CTX二组无明显差异(P>0.05)。根据T值评分的人群中,SLE组腰椎BMD低于HC组(P<0.05)。根据Z值评分的人群中,SLE组的腰椎、股骨头和髋部的BMD均低于HC组(P<0.05),见表2。参考T值评分的SLE组中正常BMD者的比例均低于HC组,其中以腰椎最多见;参考Z值评分的SLE组中腰椎、股骨颈、髋部均高于HC组。年龄大、有糖皮质激素用药史、患有冠心病、SLE高疾病活动度、低C3、低C4的SLE患者更易合并骨质松。结论年龄大、有糖皮质激素用药史、患有冠心病、SLE病情活动度高、C3、C4低的SLE患者更易合并骨质松。

Objective To investigate the risk factors of osteoporosis in patients with systemic lupus erythematosus(SLE),and to provide evidence for monitoring,prevention and treatment of osteoporosis in SLE patients.Methods A total of 105 SLE patients with osteopenia or osteoporosis were selected,including 96 females and 9 males,and 55 healthy controls matched for gender composition,age and body mass index.Detailed results of demographic information,medical history,medication history,biochemical tests,and BMD measurements were collected for both groups;a t-score was used for men and postmenopausal women≥50 years of age,and a Z-score was used for men and premenopausal women<50 years of age.Logistic regression was used to analyze the risk factors of osteoporosis.Results The proportions of hyperlipidemia,hypertension,femoral head necrosis and fracture in SLE group were higher than those in HC group(P<0.05).In the SLE group,103 patients had a history of glucocorticoids,and the average dose of glucocorticoids was(11.1±10.1)mg/day.There were 98 patients with history of immunosuppressive drugs.Serum C3 and C4 levels in SLE group were lower than those in HC group,and the differences were statistically significant(P<0.05).In terms of bone metabolism indexes,blood calcium and 25-hydroxyvitamin D in SLE group were significantly lower than those in HC group,and osteocalcin,a bone formation marker,was significantly lower in SLE group than that in HC group,and the differences were statistically significant(P<0.05).There was no significant difference in bone resorption markers PINP andβ-CTX between the two groups(P>0.05).According to the T-score,the BMD of lumbar spine in SLE group was lower than that in HC group(P<0.05).According to the Z-score,the BMD of lumbar vertebrae,femoral head and hip in SLE group was lower than that in HC group(P<0.05),as shown in Table 2.The proportion of normal BMD in SLE group with reference T score was lower than that in HC group,and lumbar vertebrae was the most common.The lumbar vertebrae,femoral neck and hip of SLE group with reference Z-score were higher than those of HC group.Patients with older age,history of glucocorticoid use,coronary heart disease,high SLE disease activity,low C3 and low C4 are more likely to be complicated with osteopenia.Conclusion Older SLE patients,history of glucocorticoid use,coronary heart disease,high SLE disease activity,low C3 and C4 are more likely to be complicated with osteopenia.