唑来膦酸治疗风湿病并发骨代谢异常急性期反应及处理对策

Acute phase reactions of zoledronic acid infusion and the possible management strategy in patients with rheumatic diseases concomitant with osteopenia or osteoporosis

目的 观察风湿病并发骨代谢异常患者使用唑来膦酸的急性期反应并总结对应策略。方法选择风湿病并发骨质疏松症,或者风湿病并发骨量低下,同时使用糖皮质激素的患者,记录唑来膦酸使用时急性期反应观察指标及药物干预情况。将患者分为系统病变组和关节炎组,长期激素组和非激素组,比较各组出现急性期反应情况。结果 纳入患者共95例,男性21例,女性74例,其中44例（46.3%）患者出现不同种类的急性反应症状共131人次。发热为最常见的急性期反应,28例（29.5%）出现发热,26例为中低度发热,2例高热;其次为头痛（22.1%）、肌痛（15.8%）和关节痛（12.6%）;21例（22.1%）患者给予药物干预。多因素Logistic分析显示关节炎组患者易出现急性期反应（OR=1.430,95%CI：1.052~1.846,P=0.020）,而长期使用激素是出现急性期反应的保护因素（OR=0.472,95%CI：0.058~0.899,P=0.013）。结论 风湿病并发骨代谢异常患者可安全使用唑来膦酸注射液,无严重急性期反应,长期使用激素可减少急性期反应的可能性。

Objective To evaluate the acute phase reactions of zoledronic acid in rheumatic diseases concomi- tant with osteopenia or osteoporosis. Methods We conducted a prospective study to access frequency of acute phase re- actions in patients with rhemnatic diseases concomitant with osteoporosis or osteopenia after infusion of zoledronic acid, Multiple regression model was applied to analyze the risk factors of acute phase reactions. Results The total of 95 pa- tients were included in this study. The most common manifestation of acute phase reactions was fever in 28 patients in to- tal. 26 patients had mild or moderate fever while 2 patients got high fever. Other common manifestations included head- ache （22. 1% ） , myalgia （ 15.8% ） and arthralgia （ 12. 6% ）. 21 patients received medicine to control the different acute phase reactions. Acute phase reactions of all patients relieved within 7 days after infusion of zoledronic acid. Multi- ple regression analysis revealed that the risk factor of acute phase reactions was that patients had arthritis （ OR = 1. 430, 95% CI： 1. 052 -1. 846, P =0. 020）, while patients with corticosteroid were less likely to have acute phase reactions （ OR = 0. 472, 95% CI： 0. 058 -0. 899, P = 0. 013）. Conclusion Patients with rheumatic diseases concomitant with osteoporosis or osteopenia had no severe acute phase reaction in prescription of zoledronic acid. Long term of corticosteroid usage may reduce the possibility of acute phase reactions.