系统性红斑狼疮并发骨坏死118例临床特点及危险因素分析

Clinical characteristics and risk factors in 118 patients with systemic lupus erythematosus and osteonecrosis

目的:分析系统性红斑狼疮(SLE)并发骨坏死的临床特点及相关危险因素。方法:选2014年1月至2019年5月北京协和医院住院的118例SLE并发骨坏死患者,同时按照性别、年龄和病程随机匹配了118例同期住院而未并发骨坏死的SLE患者,分析两者的临床表现、实验室检查、治疗等,采用logistic多因素回归分析SLE并发骨坏死的危险因素。结果:118例SLE并发骨坏死患者中女性98例,男性20例,年龄15~71岁,中位年龄27岁,病程1~168个月。SLE合并骨坏死者既往使用糖皮质激素的累计时间较SLE未合并骨坏死者长[36.5(0~168)个月比19.0(0~168)个月,P<0.05],骨质疏松症的发生(29.7%比4.2%)、免疫抑制剂的使用(83.9%比64.4%)、脏器受累数目[中位2(0~5)个比中位1(0~4)个]较SLE未合并骨坏死者多,SLE疾病活动指数(SLEDAI)(14.22±7.40比11.63±6.11)较SLE未合并骨坏死者高(P<0.05),SLE未合并骨坏死者Coombs试验阳性率较SLE合并骨坏死者高(39.8%比7.6%),差异有统计学意义(P<0.05),接受甲泼尼龙冲击治疗剂量(甲泼尼龙500~1000 mg/d×3~5 d)和比例(30.5%比31.4%)在两者间差异无统计学意义(P>0.05)。Logistic多因素回归分析显示,SLE患者SLEDAI高(OR=1.070,95%CI 1.026~1.116,P<0.005)、合并骨质疏松症(OR=10.668,95%CI 3.911~29.103,P<0.001)与骨坏死发生高风险有相关性,Coombs试验阳性与骨坏死发生低风险有相关性(OR=0.492,95%CI 0.266~0.910,P<0.05)。结论:高SLEDAI及合并骨质疏松症可能是SLE发生骨坏死的危险因素,Coombs试验阳性可能是保护性因素。

Objective To investigate the clinical characteristics and risk factors for osteonecrosis(ON)in patients with systemic lupus erythematosus(SLE).Methods This is a case-control study.A total of 118 patients diagnosed with SLE complicated with ON(study group)were retrospectively analyzed between 2014 and 2019.Gender,age,and course matched 118 SLE patients without ON were selected as controls.Clinical manifestations,laboratory findings,medical history,and treatments were recorded and analyzed.Results Among 118 patients,the male to female ratio was 20 to 98 with a median age of 27 years and course of disease 1-168 months.Compared with the control group,the study group presented a longer cumulative duration of glucocorticoid therapy[36.5(0-168)months vs.19.0(0-168)months on average,P<0.05],a higher incidence of osteoporosis(29.7%vs.4.2%,P<0.001),a higher frequency of immune-suppressive therapy(83.9%vs.64.4%,P=0.035),more organs involveed[median 2(0-5)vs.1(0-4)],and a higher SLE disease activity index(SLEDAI)(14.22±7.40 vs.11.63±6.11,P<0.05)in univariate logistic regression.The control group had a higher rate of positive Coombs test(39.8%vs.7.6%,P<0.05).No statistical difference on methylprednisolone(MP)pulse therapy(P>0.05)was observed.Multivariate logistic regression suggested that SLEDAI(OR=1.070,95%CI 1.026-1.116,P<0.005),osteoporosis(OR=10.668,95%CI 3.911-29.103,P<0.001)and a positive Coombs test(OR=0.492,95%CI 0.266-0.910,P<0.05)were related to the development of ON in SLE patients.Conclusion A higher disease activity and the presence of osteoporosis are associated with an increased risk of ON in patients with SLE,and positive Coombs test seems a protective factor of ON.