阿仑膦酸钠片对应用糖皮质激素的SLE患者骨保护作用的临床研究

目的评估阿仑膦酸钠片对系统性红斑狼疮(SLE)患者糖皮质激素诱导骨质疏松(GIOP)的预防作用。方法选取2016年1月至2018年1月于我科住院的SLEDAI评分提示稳定期的女性SLE患者50例,患者均口服糖皮质激素6个月以上,随机分为维生素D+钙剂组(对照组)、维生素D+钙剂+阿仑膦酸钠片组(观察组),给予相应治疗后,并于第0、6个月监测骨代谢指标,比较各组治疗前后骨密度变化。结果治疗后,两组血清钙、维生素D与治疗前比较差异无统计学意义(P>0.05);两组骨密度测量值均有所改善,观察组的骨密度提升更为明显(P<0.05)。结论对于长期服用小剂量激素的SLE患者,阿仑膦酸钠片可有效改善患者的骨密度,降低骨折的发生,起到骨保护作用。     

长期服用糖皮质激素治疗系统性红斑狼疮对患者骨量的影响

目的探讨长期服用糖皮质激素对系统性红斑狼疮患者骨量的影响。方法以我院2010年1月～12月间60例长期服用糖皮质激素治疗的系统性红斑狼疮患者为红斑狼疮组,以同期60例同地区相同年龄段妇女为正常组,将红斑狼疮组患者治疗前后数据及与正常组各项数据进行对比分析。结果治疗前红斑狼疮组患者与正常组骨量无显著差异（P〉0．05）,治疗后红癍狼疮组患者Ca、P、ALP较治疗前显著降低,PTH显著升高,Ward’s三角骨密度显著降低,治疗前后比较差异显著（P〈0．01）,且治疗后各项数据与正常组比较也有统计学差异（P〈O．01）。结论系统性红斑狼疮患者长期服用糖皮质激素激素对骨量影响较大,一定要采取必要措施防范骨质疏松症。     

骨矿仪在强的松治疗系统性红斑狼疮中的应用

目的:评估骨矿密度仪在用强的松治疗系统性红斑狼疮中的临床价值。方法:长期接受剂量不等的强的松治疗的115例系统性红斑狼疮患者,加用葡萄糖酸钙3g/d,采用SPA-4型骨矿分析仪以γ线吸收法测定患者右桡骨的骨矿密度含量。结果:强的松服用1年以内(5.4％)与1年以上(22％)比较,骨密度异常有显著性差异(P<0.01),强的松每天口服15mg以下(9％)比服用15mg以上(18％)对骨密度异常影响小(P<0.05),年龄小于55岁(14％)和55岁以上(42％)患者比较,骨密度变化较明显(P<0.01),30例患者骨密度不正常为70％,与X线腰椎片(不正常47％)比较,其灵敏度优于X线。结论:骨矿分析仪应用可作为监测系统性红斑狼疮治疗中强的松导致的骨质疏松的手段。     

风湿免疫病并发血小板减少76例临床分析

目的了解各类风湿免疫病并发血小板减少的临床特点。方法分析76例风湿免疫病并发血小板减少的发生率、血小板减少及出血程度和不同种类风湿免疫病并发血小板减少对各种治疗的反应。结果 76例风湿免疫病并发血小板减少患者中以系统性红斑狼疮(38.1%)、干燥综合征(32.9%)较常见。一般表现为皮肤瘀斑。骨髓象绝大多数无异常,巨核细胞成熟无障碍,血小板无减少。严重时血小板可降至15×109甚至10×109以下。出现眼、口腔甚至消化道出血,且激素加量、一般免疫抑制剂等治疗效果差。加用来氟米特后获得较好疗效,血小板升至50×109水平,自发出血停止。结论系统性红斑狼疮、干燥综合征、混合性结缔组织病并发血小板减少发生率较高。值得注意的是,干燥综合征中部分可并发显著血小板减少及出血严重,激素加量及一般免疫抑制剂治疗效果可能不佳,而来氟米特疗效较好。     

联合小剂量糖皮质激素治疗类风湿关节炎临床研究

目的通过分析糖皮质激素治疗类风湿关节炎的临床效果,提高对糖皮质激素治疗类风湿关节炎的认识。方法回顾性分析1998年3月至2005年3月有随访记录且于治疗初期即使用DMARD8的62例患者分为糖皮质激素组（28例）和非糖皮质激素组（34例）,比较两组患者疾病缓解和远期关节X线变化的差异,比较糖皮质激素治疗组中不同剂量间的近期、远期疗效。结果两组近期总有效率分别为89．3％、67．6％;两组间比较有统计学差异（P〈0．05）。糖皮质激素组中不同剂量间的近期疗效、远期疗效及不同疗程的远期疗效无统计学差异（P〉0．05）。结论糖皮质激素能快速、明显地改善活动性类风湿关节炎患者疾病活动程度,但对类风湿关节炎骨破坏无控制作用,不同剂量对近期改善类风湿关节炎疾病活动和控制骨破坏无差异。     

血浆纤维蛋白原检测在弥漫性结缔组织病诊治中的意义

弥漫性结缔组织病(connective tissue disease,CTD),是风湿性疾病中的一大类,其中包括类风湿关节炎、干燥综合征、系统性红斑狼疮等多种疾病,在我国并不少见,可造成患者多个     

重新认识糖皮质激素——糖皮质激素在风湿科的应用进展

1855年，英国医生Addison在对肾上腺机能低下的病人进行详细观察与分析以后，发现了糖皮质激素的存在，到现在已经有百余年的历史了。1949年，美国的Hench医师首次将糖皮质激素用于了类风湿关节炎的治疗，开创了此类药物在风湿病应用的先河。自此之后，糖皮质激素开始广泛的用于系统性红斑狼疮、系统性血管炎和类风湿关节炎等风湿病的治疗，取得了显著的疗效。     

女性类风湿关节炎患者使用双能X线测定前臂骨密度的价值

目的 探讨女性类风湿关节炎患者使用双能X线测定前臂骨密度的价值.方法 70例女性类风湿关节炎患者,均进行双能X线测定骨密度.比较患者腰椎、左髋部、前臂的骨密度和T值,中轴、腰椎、左髋部骨密度正常与异常患者的年龄、体质量指数(BMI)、前臂骨密度、前臂T值.结果 70例患者腰椎、左髋部、前臂的骨密度分别为(0.93±0....     

复方甘草酸苷用于治疗难治性风湿性疾病

复方甘草酸苷具有抗炎、免疫调节和抗变态反应等作用.本文综述其在多种难治性风湿性疾病如风湿热、类风湿关节炎(RA)、系统性红斑狼疮(SLE)和原发性干燥综合征等临床治疗中的应用.     

羟氯喹联合糖皮质激素致低蛋白血症患者急性药物性肝损伤1例

<正>羟氯喹(hydroxychloroquine)为4-氨基喹啉类药物,广泛应用于治疗自身免疫性疾病,如系统性红斑狼疮、类风湿关节炎等~([1])。目前推荐的有效剂量为400 mg·d-1,可达最高有效浓度~([2])。羟氯喹常见不良反应有眼底黄斑病变、神经精神系统反应、胃肠道反应、过敏反应等~([3]),引发肝功能损伤少见。多项研究报道糖皮质激素联合羟氯喹治疗自身免疫性疾病可以减少糖皮质激素的不良反应~([4,5])。本研究介绍1例低蛋白血症患者使用糖皮质激素联合羟氯喹导致急性药物性肝损伤,为临床治疗及药学监护提供参考。     

Strategies for the prevention and treatment of osteoporosis in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic disease that affects millions of patients worldwide. As better therapies emerge for treatment of this condition, patients with RA are living longer and are more likely to experience diseases associated with aging such as osteoporosis. The aetiology of osteoporosis in patients with RA is multifactorial, with some bone loss attributable to the underlying inflammatory disease. Patients may also experience bone loss that is a consequence of therapy with corticosteroids. Progress in the diagnosis and evaluation of osteoporosis has led to a greater awareness of this major health problem. There have also been many advances in our understanding of the pathophysiology of RA. However, recent studies have suggested that, despite our growing understanding of these diseases, therapies for preventing bone loss in this patient population are underutilised. Patients with RA, especially those taking corticosteroids or with persistent disease activity, must have their bone mass assessed with bone mineral density testing. RA patients with documented osteoporosis or those at high risk for the development of this potentially devastating complication should receive calcium and vitamin D supplementation as well as an anti-resorptive agent.     

Prasterone.

PURPOSE: The pharmacology, pharmacokinetics, clinical efficacy, adverse effects and toxicities, drug interactions, dosage and administration, and safety issues related to the use of prasterone are discussed. SUMMARY: Prasterone is a proprietary synthetic dehydroepiandrosterone product under investigation for use in women with systemic lupus erythematosus (SLE) who are taking glucocorticoids. Initial trials investigated prasterone as a treatment to improve disease activity and symptoms in women with mild to moderate SLE. The Food and Drug Administration (FDA) did not approve prasterone's labeling for these indications. Subsequent trials have focused on prasterone as a treatment to limit bone loss in women who have SLE. A study was conducted to assess bone mineral density in patients who had been taking glucocorticoids for six months or longer. The patients in the prasterone group showed an increase in bone mineral density, while the placebo group demonstrated a loss. The most common adverse effects of prasterone therapy were acne and hirsutism. Hematuria, hypertension, and serum creatinine concentration increases have also occurred. Interactions of prasterone potentially exist with 5-alpha reductase inhibitors and additive or antagonistic effects could possibly occur with androgens, estrogens, oral contraceptives, and progestins. In clinical trials, oral prasterone dosages of 100-200 mg/day were administered. These dosages have resulted in supraphysiological hormone levels. CONCLUSION: FDA has granted orphan drug status for the prevention of loss of bone mineral density in SLE patients taking glucocorticoids. FDA is requesting additional Phase III trial data for the treatment of SLE and the prevention of loss of bone mineral density.     

糖皮质激素治疗类风湿关节炎的初步临床分析

目的初步探讨糖皮质激素（glucocorticoids,GCs）在类风湿关节炎（rheumatoid arthritis,RA）中使用的利弊。方法随机调查53例RA患者使用GCs的情况（非激素组25例,激素组28例）,详细记录GCs使用的剂量、时间,同时测定所有患者的临床及相关实验室指标,比较非激素组和激素组RA患者间上述指标的差异。结果两组患者间年龄、BM I、病程、性别构成以及是否使用改变病情抗风湿药物等基本情况比较显示,差异无统计学意义（P〉0.05）。非激素组与激素组在关节压痛指数（21.92±15.52）vs（35.39±17.53）、关节肿胀指数（8.88±6.21）vs（12.61±6.66）、HAQ积分（0.83±0.69）vs（1.76±0.80）、患者评价（5.44±1.80）vs（6.61±1.50）、关节功能分级构成比（1∶13∶10∶1）vs（0∶5∶12∶11）、关节X线分期构成比（6∶14∶4∶1）vs（1∶12∶8∶7）及骨质疏松发生率（5/25vs13/28）的比较显示,差异有统计学意义（P〈0.05）。服用激素的总量与关节压痛指数（r=0.308,P=0.025）、HAQ积分（r=0.549,P=0.0001）、患者评价（r=0.301,P=0.028）、双手平均握力（r=-0.337,P=0.014）和桡骨远端骨密度（r=-0.362,P=0.008）呈直线相关。结论不适当使用GCs治疗的RA患者关节压痛和肿胀数更多,HAQ积分更高,患者评价、关节功能和关节X线分期更差,骨质疏松的发生率亦更高;但每日3片左右的强的松使用1.5年对RA血压、血糖和血脂的影响并不大。     

Rapid hip bone loss in active Crohn's disease patients receiving short-term corticosteroid therapy

BACKGROUND: Uncertainty over whether corticosteroids cause bone loss in patients with Crohn's disease may reflect their short, intermittent use. AIM: We investigated whether a 2-month course of prednisolone is associated with detectable bone loss. METHODS: Fifteen patients with active Crohn's disease and 19 controls with inactive Crohn's disease were recruited. Bone mineral density of the lumbar spine and hip was measured at baseline and 2 and 8 months. RESULTS: At 2 months, significant bone loss was found in patients with active disease (femoral neck -2.7%, P < 0.002; Ward's triangle -3.9%, P < 0.01). Although bone mineral density was still lower at 8 months, these differences were no longer significant (-1.3% and -3.4%, femoral neck and Ward's triangle, respectively). No significant change in hip bone mineral density was observed in controls. Previous corticosteroid use was not significantly associated with baseline bone mineral density, although significant independent associations were observed between weight, site of disease and lumbar spine bone mineral density, and between dietary calcium deficiency and femoral neck and Ward's triangle bone mineral density. CONCLUSION: Significant bone loss at the hip can be detected in patients receiving corticosteroid treatment for 2 months for active Crohn's disease ; however, it remains unclear whether this is because of disease activity or its treatment. This rapid bone loss may represent a risk factor for fracture and justify bone protective therapy.     

预防性应用VitD、钙剂对糖皮质激素治疗儿童肾病综合征骨密度的影响

目的:观察维生素D(VitD)、钙剂对应用泼尼松治疗肾病综合征(NS)患儿骨密度(BMD)的作用,探讨其变化对NS患儿骨代谢的影响及意义。方法:以本院2009年1月至2011年5月临床资料完整的激素敏感型NS患儿90例为对象,男52例,女38例,55例为初发,35例为复发病例,平均年龄(5.33±2.86)岁,随机分为A、B、C三组,每组30例。A组单用激素治疗,口服泼尼松1.5～2 mg/(kg.d),最大剂量80 mg/d,并逐渐减量,疗程9～12个月;B组在A组治疗基础上加用VitD;C组在B组治疗基础上加用钙剂治疗。所有患儿在激素治疗前、激素治疗后1个月及6个月分别测量血清钙、BMD。结果:三组患儿治疗1个月、6个月后与治疗前比较,BMD降低(P<0.01),治疗1个月后A、B组BMD下降更明显,与C组比较差异有统计学意义(P<0.05);治疗6个月后A组BMD由(0.751±0.042)g/cm2降至(0.639±0.035)g/cm2(P<0.01),B组由(0.750±0.040)g/cm2降至(0.640±0.025)g/cm2(P<0.01),较C组由(0.748±0.041)g/cm2降至(0.665±0.038)g/cm2(P<0.01)下降更明显(P<0.01);血清钙值A组由(1.940±0.068)mmol/L降至(1.742±0.048)mmol/L,B组由(1.932±0.085)mmol/L升至(2.158±0.131)mmol/L,C组由(1.921±0.083)mmol/L升至(2.338±0.081)mmol/L,差异有统计学意义(P<0.01)。结论:糖皮质激素治疗NS患儿可降低BMD,加用适当剂量VitD和钙剂可减轻但并不能完全阻止骨质疏松,未发现其他不良反应。     

A multidisciplinary renal clinic for corticosteroid-induced bone disease

A multidisciplinary clinic to manage complicated bone disease was established due to the high prevalence of osteoporosis in corticosteroid-treated patients with a history of organ transplantation or chronic glomerulonephritis. Assessments were performed by a renal clinical pharmacist, nephrology nurse, and rheumatologist. Of 70 patients (27 men, 43 women) evaluated from December 1997-June 1999, 37% had osteoporosis (30% spine, 23% hip, 16% both sites) and 34% had a history of fracture. Analysis revealed low 1,25-hydroxyvitamin D3 levels (15 patients), hormone deficiency (16), elevated parathyroid hormone (27), and history of taking at least one other risk drug in addition to corticosteroids (58). Thirty-nine percent of patients had a documented height loss (mean 1.0 in.). Other risk factors included 32 episodes of graft rejection requiring additional corticosteroids, history of smoking (24 patients), poor physical activity (40), and low dietary calcium intake (47). Drug interventions included calcium and/or vitamin D (44 patients), calcitonin (7), alendronate (20), and hormone replacement therapy (11). Preliminary results showed an increase in bone mineral density (a surrogate marker for fracture risk) of 3-5%. An organized clinic to assess osteoporosis risks can unmask a large population of patients with documented bone loss. Appropriate interventions such as drug therapy and lifestyle changes may increase bone mineral density. A long-term benefit of therapy, although not measured in this study, may be a decreased predisposition to fractures and their sequelae.     

雌激素加钙剂与钙剂对比治疗绝经后妇女骨质疏松症的骨密度测定分析

目的 对使用雌激素加钙剂与钙剂治疗绝经后骨质疏松症妇女的骨密度进行测定分析。方法 将绝经后患骨质疏松症的妇女分成两组,一组75例,每天口服结合型雌激素（贝美力）0.3mg加含钙元素1g的钙剂,连脬6个月;另一组37例,每天口服含钙元素1g的钙剂,连服6个月,用以色列MYRIAD-SOUNDSCAN-2000型骨量超声测定仪检测胫骨中段骨密度。结果 口服雌激素加钙剂组骨密度总有效率100%,口服钙剂组骨密度总有效率70.3%。结论 使用雌激素加钙剂与钙剂均可以达到增加绝经后妇女的骨密度,预防和治疗绝经后骨质疏松症的目的,使用雌激素加钙剂较单补钙剂疗效更好。     

Effect of supplementation of calcium and Vitamin D on bone mineral density and bone mineral content in peri- and post-menopause women: A double-blind, randomized, controlled trial

BACKGROUND: Osteoporosis is a serious global health problem for the future, that is why improving diagnostic methods and prevention of this disease could be helpful. OBJECTIVES: To assess the effects of calcium supplementations combined with Vitamin D on bone mineral density (BMD) and bone mineral content (BMC) in a representative sample of peri- and post-menopausal women in a double-blind, a randomized, controlled trial was untaken. DESIGN: A total of 120 women aged over 45 were included in a randomised placebo-controlled, double-blind trial on the effect of a daily dietary supplementation of calcium and Vitamin D on bone mineral density and bone mineral content; over a 30-month period. METHODS: Dietary intake assessment; dual-energy X-ray absorptiometry to measure total body and segmental bone mineral density and bone mineral content at beginning of the study and every 15 months were undertaken. RESULTS: There was no significant change in dietary calcium or Vitamin D intakes in either of the treatment groups during the 30-month intervention period. The change in total BMD in the calcium group was significantly different from that in the placebo group (P <0.005). The placebo group lost a total BMD at a rate of about 0.4% per year. There was an inverse correlation between BMD and age. CONCLUSIONS: The effect of calcium and Vitamin D supplementation on bone mineral density of calcium has been demonstrated in this group of young adult women. Our results showed the positive effect of calcium and Vitamin D supplementation in women both peri- and post-menopausal status; for this reason a supplementation of calcium and Vitamin D should be recommended as a strategic option in helping to prevent early postmenopausal bone loss.     

女性多发性肌炎及皮肌炎患者骨密度相关因素分析

目的探讨女性多发性肌炎及皮肌炎患者骨密度的变化和骨质疏松的发生情况，并讨论疾病的病情和激素用量对骨密度的影响。方法采用双能X线骨密度仪分别测量36例女性多发性肌炎及皮肌炎患者（多发性肌炎及皮肌炎组）和健康女性（对照组）的股骨颈、三角区、大转子及左前臂桡骨远端的骨密度，并同时记录多发性肌炎及皮肌炎患者的症状变化、临床指标、激素使用情况。对多发性肌炎及皮肌炎患者诸多影响骨密度的因素进行统计学分析。结果多发性肌炎及皮肌炎组中骨量减少及骨质疏松的发生率高于对照组（P〈0．05）。多发性肌炎及皮肌炎组中骨量异常的患者比骨量正常的患者年龄更大、病程更长、激素使用时间更长、激素累积用量更大（P〈0．05）。与非闭经妇女相比，闭经妇女出现骨质疏松的比例增加（P〈0.05）。多元线性回归分析发现激素的使用时间、激素的累积剂量与股骨颈骨密度值有线性回归关系。结论多发性肌炎及皮肌炎患者骨质疏松的发生率较正常人群明显增高，闭经妇女更易出现骨质疏松，激素的使用时间及累积剂量是影响骨密度的重要因素。     

南蛇藤乙醇提取物对大鼠骨创伤愈合的影响

目的研究南蛇藤乙醇提取物对大鼠骨创伤模型愈合的影响,为临床用药提供理论和实验依据。方法40只SD大鼠随机分为假手术组、模型组、阳性药组、南蛇藤乙醇提取物高剂量组和低剂量组。复制大鼠骨创伤模型,除假手术组外,各组大鼠每天1次给药,连续给药45d。给药期间观察大鼠的一般状况、伤肢活动和伤口愈合情况。末次给药后2h处死大鼠,采血分离血清,测定血清中钙、磷浓度和碱性磷酸酶水平。取股骨照骨痂X光片,分析骨痂骨密度,用折力仪测定骨痂抗折强度。结果骨创伤大鼠股骨骨痂密度、抗折力、血清钙磷含量、碱性磷酸酶水平均降低,而阳性药和高剂量南蛇藤乙醇提取物能增加血清钙、磷含量和碱性磷酸酶水平,提高骨创伤大鼠骨痂密度和抗折力（P〈0．05或P〈0．01）。结论南蛇藤乙醇提取物能有效促进大鼠骨创伤愈合。