系统性红斑狼疮并发无菌性股骨头坏死的临床研究

目的 探讨系统性红斑狼疮(SLE)并发无菌性股骨头坏死(ONFH)的临床特点.方法 回顾分析卫生部中日友好医院住院治疗的SLE合并ONFH患者的临床资料.结果 461例SLE住院患者中ONFH的发病率为6.94%(32/461),在SLE病程3年之内发生ONFH的病例占65.63%(21/32);SEE合并ONFH者与SLE未合并ONFH者间年龄、性别、病程差异无统计学意义(P>0.05);具有皮肤血管炎、血小板升高、血清纤维蛋白原(Fib)升高、LDL-C升高、骨密度低表现的患者在SLE并发ONFH者所占的比例较SLE未合并ONFH者高,平均初始口服糖皮质激素量和1个月、半年、总糖皮质激素累积量亦较SLE未合并ONFH者高,两者比较差异有统计学意义(P<0.05);而雷诺现象、口腔溃疡、肾脏受累、高血压、贫血、抗心磷脂抗体阳性、有无行糖皮质激素冲击和免疫抑制剂治疗等方面两者比较差异无统计学意义(P>0.05).结论 在SLE病程3年之内发生ONFH的危险性相对较高,SLE并发ONFH患者多数具有皮肤溃疡、坏疽等皮肤血管炎以及血小板、Fib、LDL-C升高和骨密度低的表现,且多数患者经过大剂量糖皮质激素治疗.     

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

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...     

系统性红斑狼疮并发无菌性骨坏死与糖皮质激素使用相关性的荟萃分析

目的对系统性红斑狼疮(SLE)患者并发无菌性骨坏死(AVN)的发生率与糖皮质激素用法的相关性进行荟萃分析。方法检索PubMed、Embase、CBM、CNKI数据库中已公开发表的关于SLE并发AVN与糖皮质激素使用之间关系的病例对照研究文献,筛选出符合条件的文献,用Rev Man 5. 3统计学软件评估各文献间的同质性,同质性好的合并效应量分析采用固定效应模型,同质性不好的合并效应量采用随机效应模型进行分析。结果共纳入相关文献12篇,累计病例组总样本量450例,对照组总样本量1 092例。糖皮质激素冲击疗法(OR=1. 65,95%CI=1. 20～2. 27,P=0. 002)、起始糖皮质激素用量(MD=5. 17,95%CI=2. 40～7. 94,P=0. 002)、1个月累积糖皮质激素用量(SMD=0. 23,95%CI=0. 05～0. 41,P=0. 01)与SLE并发AVE明显有关,总累积糖皮质激素用量(SMD=0. 28,95%CI=-0. 01～0. 57,P=0. 06)和平均糖皮质激素用量(SMD=0. 27,95%CI=-0. 02～0. 56,P=0. 07)与SLE并发AVE无明显相关。结论糖皮质激素冲击疗法及短期大剂量糖皮质激素使用是SLE并发AVN的危险因素。     

病态窦房结综合征患者脑梗死危险因素分析

目的:探讨病态窦房结综合征(SSS)患者脑梗死的危险因素。方法:336例SSS患者中,SSS合并脑梗死组83例,SSS不合并脑梗死组253例(对照组),回顾性分析脑梗死发生的危险因素。结果:SSS合并脑梗死组年龄明显高于对照组(P0.05),且患病率随着年龄增加而明显增加;SSS合并脑梗死组吸烟、有高脂血症史、合并冠心病、既往有心力衰竭发作史及不规律服用阿司匹林的比例明显高于对照组(P0.05)。Logistic回归分析显示:年龄、吸烟、高脂血症史及不规律服用阿司匹林是脑梗死发生的危险因素[OR=1.065(95%CI:1.029~1.102),2.128(95%CI:1.209~3.745),1.740(95%CI:1.021~2.966),1.962(95%CI:1.147~2.863)。结论:年龄、吸烟、高脂血症史及不规律服用阿司匹林是发生脑梗死的危险因素。     

系统性红斑狼疮并发无菌性骨坯死的危险因素分析

目的 探讨系统性红斑狼疮（ＳＬＥ）无菌性骨坏死（ＡＶＮ）与临床和实验室的关系。方法 统计本院发生无菌性骨坏死住院的２９例ＳＬＥ病人，同时随机抽样不伴有无菌性骨坏死的４０例ＳＬＥ和２０例皮肌炎／多发性肌炎（ＤＭ／ＰＭ）病人作为对照组。分析性别、年龄、贫血、高血压、雷诺现象、血管炎、肾脏受累、抗磷脂抗体、柯兴征以及糖皮质激素用量和免疫抑制剂的应用与ＡＶＮ发生的关系。结果 ＳＬＥ＋ＡＶＮ组的糖皮质激素治     

系统性红斑狼疮并发无菌性骨坏死的危险因素分析

目的　探讨系统性红斑狼疮（ Ｓ Ｌ Ｅ） 无菌性骨坏死（ Ａ Ｖ Ｎ） 与临床和实验室检查的关系。方法　统计本院发生无菌性骨坏死住院的２９ 例 Ｓ Ｌ Ｅ 病人,同时随机抽样不伴有无菌性骨坏死的４０ 例 Ｓ Ｌ Ｅ 和２０ 例皮肌炎／ 多发性肌炎（ Ｄ Ｍ／ Ｐ Ｍ） 病人作为对照组。分析性别、年龄、贫血、高血压、雷诺现象、血管炎、肾脏受累、抗磷脂抗体、柯兴征以及糖皮质激素用量和免疫抑制剂的应用与 Ａ Ｖ Ｎ 发生的关系。结果　 Ｓ Ｌ Ｅ＋ Ａ Ｖ Ｎ 组的糖皮质激素治疗起始量１ 、３ 、４ ～６ 、７ ～１２ 个月的剂量较 Ｓ Ｌ Ｅ 对照组大（ Ｐ＜ ００５ ～００１） ,而１３ ～２４ 个月期间两组糖皮质激素的用量无统计学差异;与不伴 Ａ Ｖ Ｎ 的 Ｄ Ｍ／ Ｐ Ｍ 组比较,上述各时期糖皮质激素用量均无差异。还发现, Ａ Ｖ Ｎ 的发生与年龄小、血管炎和较少应用免疫抑制剂相关。结论　糖皮质激素是 Ｓ Ｌ Ｅ 病人发生无菌性骨坏死的重要因素,但不是唯一因素。     

老年脓毒症并发急性肾损伤患者肾脏功能恢复的影响因素分析

【摘要】 目的 探讨老年脓毒症并发急性肾损伤（AKI）患者肾功能未恢复的影响因素。方法 回顾性分析2019年1月—2022年9月儋州市人民医院137例老年脓毒症并发AKI患者的临床资料，根据AKI确诊后90d的肾脏功能恢复情况分为恢复组和未恢复组，比较两组患者的临床指标。应用Logistic回归分析老年脓毒症并发AKI患者肾功能未恢复的独立危险因素，绘制ROC曲线评估各独立危险因素预测老年脓毒症并发AKI患者肾功能未恢复的价值。Spearman相关分析血镁水平与各临床指标的相关性。结果 本研究纳入老年脓毒症并发AKI患者137例，肾功能恢复62例，肾功能未恢复75例。多因素Logistic回归分析，结果显示高龄（OR=1.982，95%CI 1.376～3.150）、合并贫血（OR=4.938，95%CI 4.152～13.290）、尿素（OR=1.772，95%CI 1.195～2.716）、SCr（OR=2.105，95%CI 1.419～3.702）、高RDW（OR=5.370，95%CI 4.826～14.353）、低镁血症（OR=4.712，95%CI 3.973～12.650）、CRRT持续时间长（OR=1.942，95%CI 1.308～3.025）、少尿或无尿持续时间长（OR=1.873，95%CI 1.306～2.980）、肾毒性药物使用（OR=5.520，95%CI 4.973～16.228）、APACHE II评分高（OR=2.183，95%CI 1.552～3.894）、乳酸（OR=3.115，95%CI 2.317～9.913）、CRP（OR=2.773，95%CI 1.985～6.214）及PCT（OR=4.928，95%CI 4.105～14.106）水平升高是影响老年脓毒症并发AKI患者肾功能未恢复的独立危险因素（P<0.05）。ROC曲线分析显示，10项危险因素联合预测肾功能未恢复的AUC最高（0.962，95%CI 0.901～0.998），敏感度为98.6%，特异度为85.2%。结论 高龄、贫血、尿素、SCr、高RDW、低镁血症、APACHE II评分、乳酸、CRP及PCT水平是影响老年脓毒症并发AKI患者肾功能未恢复的危险因素，10项联合预测老年AKI患者肾功能未恢复具有较高的价值。     

慢加急性乙型肝炎肝衰竭患者发生感染和急性肾损伤危险因素分析*

目的 探讨慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者发生感染和急性肾损伤(AKI)的危险因素。方法 2017年9月～2019年9月我科收治的HBV-ACLF患者102例,发生感染48例,发生AKI 32例,应用Logistics回归分析影响患者并发感染和AKI的相关影响因素。结果 感染组住院天数≥15 d、存在侵入性操作、并发上消化出血、腹水、肝性脑病和糖尿病的比率分别为56.3%、37.5%、43.8%、52.1%、25.0%和16.7%,显著高于未发生感染组的24.1%、13.0%、16.7%、22.2%、5.6%和3.7% (P<0.05),感染组血清总胆红素水平(310.2±42.2)μmol/L,显著高于未感染组【(210.1±2.1)μmol/L,P<0.05】,MELD评分为(26.1±4.6),显著高于未感染组【(20.5±4.1),P<0.05】,血清白蛋白水平为(30.4±1.1)g/L,显著低于未感染组【(35.3±2.0)g/L,P<0.05】;多因素Logistic回归分析显示,住院时间长【OR(95%CI)为1.7(1.3～2.1)】、存在侵入性操作【OR(95%CI)为1.5(1.1～2.1)】、上消化道出血【OR(95%CI)为2.0(1.2～3.2)】和出现肝性脑病【OR(95%CI)为1.8(1.1～2.7)】是HBV-ACLF患者发生感染的独立影响因素;多因素回归分析显示合并糖尿病【OR(95%CI)为1.5(1.2～1.9)】和并发上消化道出血【OR(95%CI)为1.4(1.0～1.9)】是影响HBV-ACLF患者发生AKI的危险因素。结论 HBV-ACLF患者存在容易并发感染和AKI的危险因素,住院时间长,进行侵入性操作和有严重的并发症均需要认真预防和及时处理,才能提高临床救治成功率。     

Logistic分析SLE伴消化系统受累的危险因素

目的探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)合并消化系统受累的危险因素,为预防该病提供参考.方法采取回顾性方法对医院2013-06/2015-12的130例SLE患者的临床资料进行分析,分析SLE合并消化系统受累的临床资料差异性,并应用Logistic分析其危险因素.结果 130例SLE患者中42例患者伴消化系统受累,比例为32.3%.SLE合并消化系统受累患者中呼吸系统受累、SLE疾病活动指数(SLE disease activity index,SLEDAI)评分的比例差异有统计学意义(P0.05);呼吸系统受累、SLEDAI评分≥12分均是SLE合并消化系统受累的危险因素(OR均1.0,且均P0.05).结论 SLE合并消化系统受累的影响因素较多,而呼吸系统受累、SLEDAI评分均是其影响的危险因素,临床中应引起足够的重视.     

中国人群老年性痴呆发病危险因素的荟萃分析

目的 探讨中国人群老年性痴呆(AD)发生的主要危险因素,为预防决策提供依据.方法 收集1980年1月至2008年11月国内外公开发表的关于AD发病危险因素独立病例对照研究,并用RevMan软件对这些文献进行荟萃综合定量,采用卡方值和p值分析各研究结果间的统计学异质性.结果 纳入本次荟萃分析的文献共有11篇,累计病例1 420例,对照2 901例.AD发生的危险因素合并相对危险度(OR)值及95%可信区间(95%CI)分别为:痴呆家族史[OR=2.62,95% CI(1.69～4.07)];丧偶[OR=1.53,95%CI(1.21～1.93)];饮酒[OR=0.87,95%CI(0.68～1.12)];吸烟[OR=0.80,95%CI(0.67～0.95)].结论 痴呆家族史和丧偶是目前影响中国人群AD发生的危险因素.     

Aseptic necrosis and glucocorticosteroids in systemic lupus erythematosus: a reevaluation

To reassess predisposing factors in patients with systemic lupus erythematosus (SLE) who develop aseptic necrosis of bone, we studied 172 patients with SLE seen at our institution between 1975 and 1987 followed for longer than 1 year. Twenty-eight (16.3%) of these patients developed clinically apparent aseptic necrosis. In 12 of these 28 the continuous glucocorticosteroid dose was known. These 12 patients were compared to 15 controls with SLE followed for a minimum of 4.5 years for whom continuous glucocorticosteroid dosage was also known. We were unable to find any significant differences between patients with aseptic necrosis and controls in prevalence of specific lupus organ system involvement, Raynaud's phenomenon, or abnormal serological or hematological variables. Overall disease activity at the time of maximal glucocorticosteroid dosage did not differ significantly between the 2 groups but was slightly greater at the time SLE was diagnosed in the group with aseptic necrosis. Glucocorticosteroid intake during the first 1.5 years after diagnosis of SLE and during the third year after diagnosis was significantly greater for the patients with aseptic necrosis than for the control patients, as was glucocorticosteroid intake during the maximal 1, 3 and 6 months of therapy. We conclude that glucocorticosteroid intake is the major factor predisposing to aseptic necrosis in patients with SLE.     

Ischemic necrosis of bone in systemic lupus erythematosus.

Twenty-three patients with systemic lupus erythematosus (SLE) and ischemic bone necrosis are reported. All patients had received corticosteroids prior to the onset of ischemic necrosis, although one patient had received none for 13 years previously. Nineteen (83%) patients had multiple bone lesions including the femoral heads in 21 (91%) which were bilaterally involved in 15. In addition, humeral heads were affected in seven patients and the tibial plateaus, in three. The most striking feature of this group was the high incidence of Raynaud's phenomemon present in 14 (61%) of the 23 patients. Furthermore, central nervous system involvement was present in 10 (43%) patients, more prominent in those without Raynaud's (67%) than in those with vasospasm (29%). Thus, 20 of the 23 patients, or 87%, evidenced vascular abnormalities either in the form of Raynaud's phenomenon and/or systemic vasculitis.The pathogenesis of ischemic bone necrosis is discussed. In SLE, vasospasm or vasculitis, or both, augmented by corticosteroid therapy, could impede the microcirculation and result in the ischemic lesion.     

Brachial endothelial function is impaired in patients with systemic lupus erythematosus

OBJECTIVE: To verify if endothelial function is impaired in pre-menopausal women with systemic lupus erythematosus (SLE) and whether endothelial dysfunction is related to disease duration, cumulative prednisone dose, antimalarial use, anticardiolipin antibody (aCL), hypertension, Raynaud's phenomenon, disease activity score, and vasculitis. METHODS: Using high-resolution ultrasound, we measured the diameter of brachial artery at rest, during reactive hyperemia, and after glyceryl trinitrate (GTN). We compared 69 pre-menopausal female patients with SLE (mean age 29 +/- 8 years) with 35 age and sex-matched controls (mean age 29 +/- 6 years), The mean disease duration was 72 months. RESULTS: There was no significant difference in baseline brachial artery diameter. The flow-mediated dilation (endothelial dependent dilation) was significantly impaired in SLE patients when compared to controls (5.0 +/- 5.0% vs 12.0 +/- 6.0%, p < 0.001), even in the subgroup of patients without coronary artery disease risk factor (4.5 +/- 4.0% vs 12.0 +/- 6.0%, p < 0.001). The GTN induced dilation (endothelial independent dilation) was significantly lower in the aCL positive SLE patients when compared to the controls (11.9 +/- 4.0% vs 16.3 +/- 6.0%, p < 0.05). The endothelium-dependent dilation was not related to disease duration, cumulative prednisone dose, antimalarial use, anticardiolipin antibody, hypertension history, Raynaud's phenomenon, SLE disease activity score or vasculitis. CONCLUSION: This is the first study using brachial artery ultrasound imaging to evaluate endothelium function in SLE. Patients with SLE presented lower flow mediated dilation (endothelium dependent dilation) than sex and age-matched controls, even in patients without traditional cardiovascular risk factors and this may represent an early atherosclerotic process.     

Digital ulcers/gangrene and immunoglobulin classes/complement fixation of anti-dsDNA in systemic lupus erythematosus patients

The immunoglobulin classes/complement fixation of anti-dsDNA were studied in sera obtained from 17 systemic lupus erythematosus (SLE) patients with digital ulcers and/or gangrene (Group A); 13 SLE patients with leg ulcer, peripheral neuropathy or livedo (Group B); 24 SLE patients with Raynaud's phenomenon (Group C); and 18 SLE patients with active lupus nephritis (Group D). Antibodies to dsDNA of IgG and IgA classes were commonly present (often in high titers) in Groups A and D. However, complement fixation of anti-dsDNA was more common in Group D than in any of the other 3 groups.     

Bilateral aseptic necrosis of the lunate in systemic sclerosis

A case of scleroderma with severe Raynaud's phenomenon and vasculitis is presented, in whom bilateral aseptic necrosis of the lunate bones developed. To my knowledge, this is the first such case in the literature.     

系统性硬化病患者死亡危险因素分析

目的 了解预测系统性硬化病(SSc)患者死亡的相关因素,以指导临床治疗.方法 回顾性收集门诊和病房的资料完整诊断明确的146例SSc患者的临床资料,包括起病年龄、性别、病程、雷诺现象、皮肤受累程度、胃食管反流、肾损害、硬皮病肾危象、心脏损害等情况,检测其血清中抗Scl-70、抗着丝点抗体、抗RNP抗体,应用超声心动图方法 检测其肺动脉压,应用影像学方法 检测其是否具有间质性肺炎,使用Cox回归方法 分析患者死亡相关的危险因素.结果死亡组患者和存活组患者雷诺现象、胃食管反流、抗核抗体、抗scl-70抗体、抗着丝点抗体、间质性肺炎、弥散功能下降、冠心病、外周动脉硬化发生率差异均无统计学意义(P>0.05);死亡组患者中起病年龄>60岁者更多(P=0.002)、男性更多(P=0.023);死亡组患者弥漫型皮肤受累(P=0.000)、抗RNP抗体阳性(P=0.014)、肺动脉高压(P=0.000)、心脏损害(P=0.000)、脑梗死(P=0.035)、肾损害(P=0.000)、硬皮病肾危象较存活组更常见(P=0.000).Cox回归分析表明,发病年龄>60岁[OR=5.441,95%可信区间(CI)(2.126～13.926,P=0.000]、男性(OR=5.531,95%CI 2.014～15.190,P=0.001)、抗RNP抗体阳性(OR=2.664,95%CI 1.016～6.592,P=0.034)、弥漫型皮肤受累(OR=3.432.95%CI 1.400～8.411,P=0.007)、肺动脉高压(OR=25.718,95%CI 5.954～111.085,P=0.000)、心脏受累(OR=4.141,95%CI 1.685～10.159,P=0.002)、肾脏受累(OR=4.214,95%CI 1.654～10.737,P=0.003)、硬皮病肾危象(OR=20.677,95%CI 4.161～102.764,P=0.000)是预测SSc死亡的危险因素,尤其是严重肺动脉高压(OR=55.809,95%CI 12.879～241.832,P=0.000)是SSc患者死亡的最强预测因素.结论 对于发病年龄>60岁、男性、弥漫型皮肤受累、抗RNP抗体阳性、心脏受累、肾受累、硬皮病肾危象及肺动脉高压患者,尤其是重度肺动脉高压患者,应积极治疗以改善其预后.     

Angiotensin-converting enzyme gene polymorphism and vascular manifestations in Korean patients with SLE

Systemic lupus erythematosus (SLE) is an inflammatory multisystem disease of unknown etiology with immunologic aberrations. Many studies have shown that genetic and environmental factors are implicated in the development of SLE. Angiotensin-converting enzyme (ACE) affects various immune phenomena through the renin-angiotensin and kallikrein-kininogen systems by creating angiotensin II and inactivating bradykinin. We investigated the correlation between insertion/ deletion polymorphism of the ACE gene and the clinical manifestations of SLE, especially vascular involvement and lupus nephritis. Two-hundred and eleven Korean patients fulfilling the ACR criteria and 114 healthy subjects were enrolled. The ACE genotype was determined by polymerase chain reaction using genomic DNA from peripheral blood. The nephritis patients were classified by the WHO classification. In addition, the activity and chronicity index were used to assess the severity of renal involvement. We evaluated vascular involvement by the presence or absence of hypertension, Raynaud's phenomenon, livedo reticularis, antineutrophil cytoplasmic antibody and the SLICC/ACR Damage Index. The gene frequency of ACE gene polymorphism was as follows: II 39 vs 34%, ID 41 vs 50%, DD 20 vs 16% in SLE patients and controls, respectively. There was no difference in genotype frequency between both groups. There were no significant differences between the distribution of ACE gene genotypes and lupus nephritis and its related parameters, including WHO classification, activity index, chronicity index, renal dysfunction and amount of 24 h urinary protein. The ACE genotypes and alleles did not affect the presence of vascular manifestations evaluated, but the frequency of DD genotype was significantly low in SLE patients with Raynaud's phenomenon compared to those without Raynaud's phenomenon (P = 0.002 for ACE ID vs DD and II, OR 2.7, 95% CI 1.43-5.09; P=0.023 for ACE DD vs ID and II, OR 0.33, 95% CI 0.12-0.89). Also skewing from DD to II genotype was noted in patients with anti-Sm antibody compared to those without anti-Sm antibody (P = 0.025 for ACE DD vs ID and II, OR 0.21, 95% CI 0.05-0.93). The onset age of serositis was older in patients with the ID genotype than the others (ID= 34.5+/-10.8, II + DD = 25.6+/-10.2, P= 0.002). Also the onset age of malar rash was older in patients with II genotype than the others (II=26.7+/-8.4, ID+DD=21.3+/-9.0; P=0.021). The patients with I allele showed a significantly higher frequency of serositis (P = 0.022). Taken together, the I/D polymorphisms of ACE gene did not affect susceptibility of SLE, lupus nephritis and the vascular manifestations, including Raynaud's phenomenon, in Korean SLE patients, although the DD genotype was negatively associated with Raynaud's phenomenon among SLE patients. However, it would be valuable to evaluate the role of other genes potentially related to vascular events, such as endothelin, nitric oxide or angiotensin II receptor as well as ACE gene.     

Risk factors for avascular bone necrosis in patients with systemic lupus erythematosus

The objective was to investigate the predictive factors for avascular necrosis (AVN) of bone in patients with systemic lupus erythematosus (SLE). The records of 868 patients with SLE from four centers were reviewed retrospectively. Forty-nine patients with AVN were identified. A total of 154 patients with SLE who did not have clinically apparent AVN during the follow-up were evaluated as a control group. The demographic, clinical, laboratory and management characteristics of these two groups of patients were recorded according to predefined protocol and compared. The prevalence of AVN was detected 6% in our SLE population. The highest dose corticosteroid administered within 4?months and total cumulative prednisolone dose were significantly higher in the SLE patients with AVN. The use of cytotoxic agent significantly higher proportion of patients with AVN. AVN tends to develop more frequently in male gender and younger patients. Oral ulcer, pleuritis, Raynaud??s phenomenon, cutaneous vasculitis, lymphadenopathy, autoimmune thyroiditis, peripheral neuropathy and Sj?gren??s syndrome were higher incidence in SLE patients with AVN. The bilateral femoral heads were the commonest site of involvement of AVN in our patients with SLE.     

Avascular necrosis of bone in systemic lupus erythematosus: possible role of haemostatic abnormalities.

The pathogenesis of avascular necrosis of bone (ANB) was investigated in 111 patients with systemic lupus erythematosus (SLE) (24 with ANB, 87 without ANB); patients' ages, corticosteroid treatment, clinical and laboratory features associated with SLE, and haemostatic profiles were all taken into account. The mean ages of patients with and without ANB at the time of diagnosis of SLE was 24.1 and 31.2 years respectively. The mean maximal daily dose of prednisolone in the group with ANB was 50.8 mg, which was significantly higher than the dose (41.8 mg) in the group without ANB. Disease features of SLE, such as Raynaud's phenomenon, hyperlipidaemia, nephrotic syndrome, hypertension, and disease activity, were not found to be related to ANB. The percentage of patients who had lupus anticoagulant as well as a shorter activated partial thromboplastin time was greater in those with ANB than in those without. Multiple factors may be involved in the pathogenesis of ANB in SLE, and it is suggested that haemostatic abnormalities, which could be influenced by corticosteroids and young ages, play some part in the development of ANB.