系统性红斑狼疮首年髋关节骨流失率与股骨头坏死关系研究

Study on the relationship between hip bone loss rate and femoral head necrosis in patients with systemic lupus erythematosus one year after the disease

目的探索继发股骨头坏死(ONFH)的SLE患者初诊时、1年后复诊及末次就诊时骨密度减少的变化规律。方法回顾性分析2019年1月至2020年12月在西安交通大学第一附属医院风湿免疫科住院的107例SLE患者,其中23例发生ONFH的患者纳入坏死组,84例未发生ONFH患者纳入非坏死组。收集2组患者初次诊断SLE时腰椎、髋部的骨密度数据,运用倾向性评分匹配(PSM)法对坏死组和非坏死组患者进行1∶2匹配(20例和40例),使组间一般人口学特征、BMI、SLEDAI、初始激素用量和初始腰椎及髋部骨密度均衡。收集2组患者1年后复诊及末次就诊复查的腰椎/髋部骨密度(BMD)数据,比较初诊第1年的腰椎/髋部骨密度减低值、减低比例;比较全观察期腰椎/髋部骨密度减低值、减低速率。对107例SLE患者以logistic回归分析验证上述骨密度参数与ONFH的相关性,通过ROC曲线确定参数对ONFH判断的灵敏度和特异度。结果ONFH组的SLE患者髋部BMD在SLE确诊第1年降低了6.83%,高于非坏死组[(-6.828±6.212)%和(0.753±2.058)%,t=5.31,P<0.001];logistics回归分析提示第1年髋部BMD下降率增加了ONFH的发生风险[OR(95%CI)=12.346(3.106,47.619),χ^(2)=12.76,P<0.001];1年期髋部骨密度下降率用于预测ONFH的曲线下面积(AUC)最大,最佳预测界值0.92%,对应的灵敏度为92.9%,特异度为91.3%。结论SLE患者初诊后第1年髋部骨流失率与ONFH风险正相关,流失率大于0.92%提示ONFH风险升高。

Objective To investigate the changes of bone mineral density loss in systemic lupus erythematosus(SLE)patients with secondary necrosis of femoral head(ONFH)at the first time being diagnosed,1 year later and the last visit.Methods One hundred and seven patients with SLE who were hospitalized in the Department of Rheumatology and Immunology of the First Affiliated Hospital of Xi′an Jiaotong University from January 2019 to December 2020 were retrospectively analyzed.Among them,23 patients in the experimental group developed femoral head necrosis and 84 patients without ONFH were served as the control group.Bone density data of lumbar spine and hip were collected at the time of initial diagnosis of SLE in the two groups.Propensity score matching(PSM)method was used to match the patients in the femur head necrosis group and the non-necrosis group 1∶2(n=20 vs.n=40).General demographic characteristics,BMI,SLEDAI,initial glucocorticoid dosage,and initial lumbar and hip bone mineral density were comparable between groups.Lumbar/hip bone mineral density(BMD)data of the two groups were collected after 1 year′s return visit and at the last visit,and the reduction value and proportion of lumbar/hip BMD in the first year of initial diagnosis were compared.The BMD reduction and rate of lumbar spine/hip were compared during the whole observation period.logistic regression analysis was performed to verify the correlation between the above BMD parameters and ONFH in 107 SLE patients,and the sensitivity and specificity of the parameters to ONFH were determined by ROC curve.Results Hip BMD of SLE patients in the femur head necrosis group decreased by 6.83%in the first year after SLE diagnosis,which was higher than that in the non-necrosis group[(-6.828±6.212%)vs.(0.753±2.058)%,t=5.31,P<0.001].Logistics regression analysis suggested that the decrease rate of hip BMD in the first year increased the risk of femoral head necrosis[OR(95%CI)=12.346(3.106,47.619),χ^(2)=12.76,P<0.001],the one-year hip BMD decline rate had the largest AUC for predicting ONFH,with the best prediction threshold of 0.92%,the corresponding sensitivity and specificity was 92.9%,and 91.3%respectively.Conclusion The hip bone loss rate is positively correlated with the risk of femoral head necrosis in the first year after initial diagnosis of lupus erythematosus.The loss rate greater than 0.92%indicates an increased risk of femoral head necrosis.