系统性红斑狼疮合并无菌性股骨头坏死的危险因素分析

Risk factors for osteonecrosis of the femoral head in patients with systemic lupus erythematosus

目的探讨系统性红斑狼疮(SLE)患者发生无菌性股骨头坏死(ONF)的相关因素。方法以37例女性SLE合并ONF患者为SLE-ONF组,随机选择同期住院的74例无ONF的女性SLE患者和30例无ONF的皮肌炎/多肌炎(DM/PM)患者作为对照组,对各研究因素进行单因素统计分析以及多因素Logistic回归分析。结果单因素分析结果显示:膝关节疼痛、贫血、狼疮疾病活动积分(SLEDAI)、抗核小体抗体(AnuA)、抗SSB抗体、血浆凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、超敏C反应蛋白(Hs-CRP)、突然停用激素、激素起始量大于60mg/d,治疗第1个月内激素平均日用量大于60 mg/d以及第2、3月激素平均日用量,第4～6月激素平均日用量,第10～12月激素平均日用量与SLE患者发生ONF相关联(P<0.05或0.01),其中抗SSB抗体阳性与ONF的发生呈负相关性(P=0.001);各阶段的激素用量在SLE-ONF组与PM/DM组之间差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示:高水平的AnuA、抗SSB抗体阳性、膝关节疼痛、突然停用激素、激素起始剂量大于60mg/d与SLE患者发生ONF相关联(P<0.05)。结论糖皮质激素和SLE疾病本身都是发生ONF的重要因素。

Objective To analyze risk factors for osteonecrosis of the femoral head（ONF） patients with systemic lupus erythematosus（SLE）.Methods SLE-ONF group was made up of 37 female SLE who developed ONF.74 female SLE patients and 30 polymyositis（PM）/dermatomyositis（DM） female pations without ONF were selected randomly from in-patients of the same time as the control groups Univariate analysis and multiple logistic regression analysis were applied for associated impact factors.Results Univarriate analysis revealed significant differences in the following variables between the two groups： knee pain,anaemia,SLE disease activity index（SLEDAI）,anti-nucleosome antibodies（AnuA）,anti-SSB antibodies,prothrombin time（PT）,activated partial thromboplastin time（APTT）,hypersensitive C-reactive protein（Hs-CRP）,sudden stop of glucocorticoid,the initial prednisolone dose more than 60 mg/d,mean daily prednisolone dose more than 60 mg/d in the first month,and mean daily dose of the second/third month,4 th/6th month and 10th/12th month（all P0.05 or 0.01）.Positive anti-SSB antibodies was negatively correlated with the occurrence of ONF（P=0.001）.There was no statistical significance of glucocorticoid ingestion at any stage between the SLE-ONF group and DM/PM group. Multiple factor logistic regression analysis revealed that high level of AnuA, positive anti-SSB antibodies,knee pain,sudden stop of glucocorticoid,and the initial dose of prednisolone over 60 mg/d,were associated with ONF（P0.05）.Conclusion Both glucocorticoid and SLE disease itself are important factors for the development of ONF.