女性系统性红斑狼疮患者骨密度与骨代谢生化参数的相关性

A Study on Correlation between Bone Mineral Density and Biochemical Parameters of Bone Metabolism in Female Patients with Systemic Lupus Erythematosus

目的 测定绝经前女性系统性红斑狼疮患者骨密度 (BMD)与骨代谢的生化参数并探讨二者的相关性。方法 用双能量x线吸收测量仪测定 3 0例SLE患者腰椎和股骨BMD ;常规测定分别测定 3 0例SLE患者和 3 9名正常健康者校正后的血清钙、磷、碱性磷酸酶、肌酐和白蛋白 ,用ELISA法测定卵泡促激素、黄体生成素、甲状旁腺素、骨钙素、脱氧吡诺林的分泌 ,用RIA法测定雌二醇、孕酮、睾丸酮、2 5 -OH维生素D、I型原胶原C端前肽、碱性磷酸酶骨特异性同工酶、交联的I型胶原端肽。结果 根据世界卫生组织的标准 ,在腰椎位点 3 9%患者BMD正常 ,46%患者骨质减少 ,15 %患者骨质疏松 ;在股骨颈位点 ,3 8 5 %患者BMD正常 ,3 8 5 %患者骨质减少 ,2 3 %患者骨质疏松。狼疮患者骨钙素、血清磷显著性降低 ( P =0 0 3、P =0 0 0 2 ) ,而患者校正后的血清钙则显著性升高 (P =0 0 0 0 1) ;除了患者睾丸酮的血清水平降低和卵泡促激素血清水平升高外 (P =0 0 0 1、P =0 42 ) ,其它性激素水平没有显著性差异。结论 绝经前女性SLE患者腰椎和股骨颈的骨质疏松和骨质减少发生率高 ,至少部分因骨形成的减少所致。

Objective To determine bone mineral density (BMD) and biochemical parameters of bone metabolism in premenopausal female patients with systemic lupus erythematosus(SLE), and investigate the correlation between them. Methods Lumbar and femoral BMD in 30 female patients with SLE was determined by dual energy X ray absorptiometry. In 30 female patients and 39 controls, the corrected serum levels of calcium, phosphorus, alkaline phosphatase, creatinine and albumin were measured by routine methods, and bone specific isoform of alkaline phophatase, propeptide of type 1 procollagen, deoxypyridinoline excretion, telopeptide of type 1 collagen, osteocalcin, parathyroid hormone, 25-OH vitamin D, testosterone, progesterone, estradiol, follicle stimulating hormone and luteinotropic hormone were measured by ELISA or RIA. Results According to the WHO criteria, 39% patients with SLE had normal BMD, 46% had osteopenia and 15% had osteoporosis at the lumbar spine; at the femoral neck 38.5% had normal BMD, 38.5% had osteopenia and 23% suffered form osteoporosis. All other bone resorption and formation markers measured were not significantly different except significantly higher corrected serum levels of albumin calcium (P=0.0001)and significantly lower osteocalcin level and phosphorus value(P=0.03,P=0.002) were found in the SLE patients. Of all sex hormones tested lower testosterone and higher follicle stimulating hormone concentration were seen in patients with SLE(P=0.001,P=0.42). Conclusion A high incidence of osteopenia and osteoporosis was found in premenopausal patients with SLE, which seems to be attributable, at least in part , to decreased bone formation in SLE patients.