系统性红斑狼疮患者骨矿物质密度的研究

目的：了解系统性红斑狼疮（SLE)患者骨矿物质密度（BMD）的变化，并讨论病的病情和激素对骨密度的影响。方法：测定健康对照组、初诊SLE组（A组）、SLE激素治疗组（B组）的BMD、血钙、磷、骨特异性碱性磷酸酶（ALP）和甲状旁腺激素（PTH）。并将B组病人分为骨质疏松组和非骨质疏松组，对两组的病程、体重指数、发病年龄、疾病的活动指数（SLEDAI）、系统损害的指数（SLICC／ACR DI）、激素的累积剂量和当前量进行统计学分析。结果；A组与正常对照组比较各项 指标差异无显著性（P＞0．05）；B组腰椎BMD、骨特异性ALP均显著低于正常对照组（P＜0．05），PTH显著高于正常对照组（P＜0．05）。B组骨质疏松的发生率17．4％。骨质疏松组与非骨质疏松组比较有较长的病程（P＜0．01）、较高的累积激素用量（P＜0．01）和较高的SLICC／ACR DI（P＜0．05）。结论：骨质疏松是年轻的SLE患者的常见病变，疾病的病程越长和系统损伤指数越高伴随骨质疏松的危险越大，但激素的影响与骨质疏松的发生是有关的。

Determinants of bone mineral density in systemic lupus erythematosus

Objective To evaluate bone mineral density (BMD) in young ambulatory female patients with systemic lupus erythematosus (SLE) and to assess the influence of corticosteroids on BMD.Methods Lumbar BMD was measured by dual X ray absorptiometry (DXA) in healthy controls,patients with SLE untreated (group A) and patients with SLE treated with corticosteroids (group B).Variables evaluated were:disease duration,clinical pattern,disease activity (SLEDAI),cumulative damage index (SLICC/ACR DI),cumulative prednisone done,and duration of steroid treatment.Osteoporosis was defined as a T score below 2 5 s compared to a reference population of healthy women.Results Lumbar BMD was significantly lower in group B than in healthy controls.Osteoporosis was detected in 17 4% of group B.In group B,compared with non osteoporotic patients with SLE,women with osteoporosis had significantly longer disease duration ( P <0 01),higher cumulative steroid intake ( P <0 01),and higher SLICC/ACR DI score( P <0 05).Conclusion Osteoporosis is a frequent feature in young patient with SLE.Disease duration and SLICC/ACR DI are associated with an increased risk for osteoporosis,but the role of glucocorticoid treatment seems to be crucial.Steroid exposure was the only treatment related variable exerting an influence on the development of osteoporosis.