系统性硬皮病妇女骨密度测定的探讨

Bone density in premenopausal women with systemic scleroderma

目的 了解系统性硬皮病 (SSc)绝经前女性患者的骨量变化及糖皮质类固醇激素 (简称激素 )对其骨量变化的影响。方法 应用英国McCueCuBA公司生产的Clinical型定量骨超声测定仪 ,对 5 8例绝经前女性SSc患者 (35例服激素 ,2 3例未服激素 )的左脚跟骨作了宽频超声衰减 (BUA)和超声传导速度 (VOS)测定 ,其中 19例SSc患者在滤泡期同步测定血清雌二醇 (E2 )均与 2 3名正常对照者进行比较分析。结果 SSc患者服激素组BUA和VOS测定值均显著低于SSc患者非激素组(P <0 0 0 1)及正常对照组 (P <0 0 0 1) ,骨质疏松、骨量缺少的发生率显著高于SSc患者非激素组 (P<0 0 0 1)及正常对照组 (P <0 0 0 1)。SSc患者非激素组和正常对照组比较 ,BUA和VOS测定值差异均无显著性 (P >0 0 5 )。结论 绝经前女性SSc患者激素组BUA和VOS均明显下降 ,骨量减少 ;非激素组BUA及VOS和正常人比较差异均无显著性 ,显示SSc并非全身性骨质疏松的危险因子。而SSc患者骨量减少发生率较高和此病不少患者长期服用糖皮质类固醇激素有关。

Objective To find out the change of bone density in premenopausal women with systemic scleroderma (SSc) and its association with gluecorticosteroid.Methods Using a clinical bone densitometer manufactured by British McCue CuBA Cobroadband ultrasound attenuation (BUA) and velocity of sound (VOS) were measured at the left heel bone in 58 premenopausal patients with systemic scleroderma.Among them,35 patients had taken gluecorticosteroid,and the other 23 had not.Levels of serum estradiol (E 2) in 19 out of 58 patients with systemic scleroderma were determined and compared with healthy controls.Results Levels of broadband ultrasound attenuation and velocity of sound measured in permenopausal patients with systemic scleroderma who had taken gluecorticosteroid were significantly lower than those in ones who had not taken gluecorticoseroid ( P <0 001) and normal controls ( P <0 001).The occurrence rate of osteopenia and osteoporosis was significantly higher in patients with taking gluecorticosteroid and normal controls than in ones without.There was no significant statistical difference in the level of BUA and VOS between patients without taking gluecorticosteroid and normal controls ( P >0 05).Conclusion The bone mineral density and the level of BUA and VOS in premenopausal patients with systemic scleroderma,who had taken gluecorticosteroid,are obviously decreased,but there is no significant difference between patients without taking gluecorticosteroid and healthy controls.It indicates that systemic scleroderma is no dangerous factor of osteoporosis.And bone density in premenopausal patients with systemic scleroderma is related with the patients who have taken gluecorticosteroid for a long time.