长期强的松治疗对绝经前SLE患者骨密度的影响

The influence of long-term glucocorticoid use on bone mineral density in premenopausal women with SLE

目的 探讨长期强的松治疗对绝经前系统性红斑狼疮（sLE）患者骨密度的影响。方法 142例SLE患者均为绝经前女性，年龄12～40岁（平均29．5岁）。正常对照78例女性，年龄15～39岁（平均28．9岁），排除影响骨代谢的各种急慢性疾病。应用HOLOGIC QDR4500双能量X线骨密度仪检测腰椎和股骨近端的骨密度值，测定血清雌二醇、雌三醇。结果 ①绝经前SLE患者骨量减少、骨质疏松发生率分别为42．96％、14．79％，均显著高于正常对照组（P值均〈0．01）；②骨质疏松和骨量减少患者服用强的松的时间、总剂量均显著高于骨量正常患者（P值均〈0．01）；③绝经前患者雌二醇与正常对照无显著差异，而雌三醇明显升高（P〈0．01）。结论 ①长期服用强的松的绝经前SLE患者骨量减少和骨质疏松发生率均显著增高；②SLE患者骨量减少和骨质疏松的发生与使用强的松的时间和总剂量有关；③绝经前SLE患者雌三醇产生增多，可能对骨密度具有保护作用。

Objective To evaluate the influence of long-term glucocorticoid（Gc） use on bone mineral density in premenopausal women with systemic lupus erythematosus（SLE）. Methods 142 patients with SLE were studied. All were women ages ranged from 12-40 years with a mean age of 29.5 years.78 women without any acute or chronic diseases which could affluence bone metabolism were observed as control group. Lumbar vertebrae and proximal femur BMD were measured with a HOLOGIC QDR 4500 Dual Energy X-ray Absorptiometry. Serum stradiol and estriol were measured as well. Results Osteopenia and Osteoporosis were found in 42.96% and 14.79% SLE patients respectively. Compared with the normal control group, BMD decreased（ P 〈 0.01 ） in proximal femur of these SLE. In patients with osteoporosis and osteopenia, both the occasion and total dosage of taking steroid were significantly higher than normal bone mineral content patients（ P 〈 0.01 ）. There was no significant difference for stradioI between patients and control group. But there was a higher estriol in patients （P 〈 0.01 ）. Conclusions The prevalence of osteopenia and osteoparosis were 42.96% and 14.79% in premenopausal SLE patients with long-term treated by Gc. of them were higher than control group. In SLE patients, the occurrence of osteopenia and osteoporosis was associated the occasion and total dosage of taking Gc. Estriol is produced more in premenopausal SLE patients, which can slow bone lose.