系统性红斑狼疮并发股骨头坏死的临床特点及危险因素分析

Analysis of Clinical Characteristics and Risk Factors of Systemic Lupus Erythematosus Complicated with Osteonecrosis of the Femoral Head

目的:探索系统性红斑狼疮(SLE)并发股骨头坏死(ONFH)患者的临床特点及其危险因素。方法:回顾性收集2016年1月至2022年6月在郑州人民医院治疗的SLE患者的临床资料。共17例并发ONFH的患者组成ONFH组,同时随机抽取51例未并发ONFH的SLE患者作为对照组。比较2组SLE患者的一般情况、临床特征、实验室检查,及治疗情况,并采用二元Logistics回归进行多因素分析。结果:ONFH组纤维蛋白原>3.5 g·L^(-1)、白细胞减少、抗β2GPⅠ抗体阳性的比例均高于对照组(P<0.05);ONFH组病情复发率(41.18%)明显高于对照组(15.69%),但差异无统计学意义(P=0.063)。多因素Logistic回归分析发现,病情复发(OR=4.194,95%CI=[1.053,16.702],P=0.042)、纤维蛋白原>3.5 g·L^(-1)(OR=9.974,95%CI=[1.457,68.286],P=0.019)是SLE并发ONFH的危险因素。进一步分组分析发现,病情复发的SLE患者中,糖皮质激素(GC)治疗时间及GC累积量>10 g的比例均高于未复发者(P<0.05)。结论:病情复发及纤维蛋白原>3.5 g·L^(-1)是SLE患者并发ONFH的危险因素。病情复发患者ONFH风险增高可能与GC治疗时间及累积量增加有关。

Objective:To explore the clinical characteristics and risk factors of patients with systemic lupus erythematosus(SLE)complicated with osteonecrosis of the femoral head(ONFH).Methods:Clinical data of SLE patients treated at Zhengzhou People's Hospital from January 2016 to June 2022 were retrospectively collected.A total of 17 patients with concurrent ONFH were included in the ONFH group,while 51 SLE patients without concurrent ONFH were randomly selected as the control group.The general condition,clinical features,laboratory tests,and treatment status of two groups of SLE patients were compared,and a multivariate analysis was conducted using binary logistics regression.Results:The proportions of fibrinogen>3.5 g·L^(-1),leukopenia,and positive anti-β2GPⅠantibodies in the ONFH group were higher than those in the control group(P<0.05);the recurrence rate in the ONFH group(41.18%)was significantly higher than that of the control group(15.69%),but the difference was not statistically significant(P=0.063).Multivariate logistic regression analysis revealed that disease recurrence(OR=4.194,95%CI=[1.053,16.702],P=0.042)and fibrinogen>3.5 g·L^(-1)(OR=9.974,95%CI=[1.457,68.286],P=0.019)are risk factors for SLE complicated with ONFH.Further grouping analysis revealed that among SLE patients with disease recurrence,the proportion of glucocorticoid(GC)treatment time and GC accumulation>10 g were higher than those without recurrence(P<0.05).Conclusion:Disease recurrence and fibrinogen>3.5 g·L^(-1)are risk factors for ONFH in SLE patients.The increased risk of ONFH in patients with disease recurrence may be related to the increased duration and cumulative amount of GC treatment.