系统性红斑狼疮合并骨质疏松的影响因素研究

目的 探讨SLE患者合并骨质疏松的潜在危险因素。方法 在中山大学附属第三医院、福建省立医院、赣州市立医院、汕头大学医学院第二附属医院4个中心使用PSM配对的方法,从中筛选125例性别和年龄匹配的SLE患者（SLE组）和125名健康受试者（HC组）,收集其临床资料,并对其进行腰椎、股骨头和全髋关节的骨矿物密度（BMD）测量,对男性和绝经后 ≥50岁的女性使用T值评分,男性和绝经前< 50岁的女性使用Z值评分。通过logistic回归分析2组研究对象发生骨质疏松的危险因素。结果 在参考T值评分的人群中,SLE组的腰椎BMD低于HC组（P < 0.05）。在参考Z值评分的人群中,SLE组的腰椎、股骨头和全髋关节的BMD均低于HC组（P均< 0.05）。此外,在T值和Z值组中,SLE组BMD异常的概率均高于HC组（P均< 0.05）。参考T值评分的SLE组中正常BMD者的比例均低于HC组,其中以腰椎的情况最为严重;而以Z值评分的SLE组中低于正常值者的比例在各个部位均高于HC组。在SLE组中,病程较长、有糖皮质激素使用史、年龄> 50岁、冠状动脉粥样硬化性心脏病（冠心病）是骨质疏松的危险因素。结论 病程较长、有糖皮质激素使用史、年龄> 50岁、冠心病的SLE患者可能是骨质疏松的高危人群。

Risk factors of systemic lupus erythematosus complicated with osteoporosis

Objective To investigate the potential risk factors of the incidence of osteoporosis in patients with systemic lupus erythematosus （SLE）. Methods In this study, 125 sex- and age-matched SLE patients （SLE group） and 125 healthy controls （HC group） were screened from the Third Affiliated Hospital of Sun Yat-sen University,Fujian Provincial General Hospital, Ganzhou Municipal Hospital and the Second Affiliated Hospital of Shantou University Medical College using the PSM matching method. Clinical data were collected. Bone mineral density （BMD） of the lumbar spine, femoral neck and total hip was measured. T values in male and postmenopausal female aged≥50 years were calculated and Z values in male and premenopausal female aged < 50 years were calculated. The risk factors of the incidence of osteoporosis in SLE patients between two groups were identified by logistic regression analysis. Results The lumbar spine BMD （T value） in patients with SLE was lower than that in the HC group （P < 0.05）. The lumbar spine, femoral neck and total hip BMD （Z value） in the SLE group were lower than those in the HC group （all P < 0.05）. Besides, the probability of abnormal BMD regarding the T and Z values in the SLE group was higher compared with that in the HC group （both P < 0.05）. In the SLE group, the proportion of normal BMD according to the T value was lower than that in the HC group, especially the lumbar spine. In the SLE group, the proportion of lumbar spine, femoral neck and total hip BMD （Z value） lower than normal level was higher than that in the HC group. In the SLE group, long disease duration, history of glucocorticoid use, age > 50 years and coronary artery disease were the risk factors of osteoporosis in SLE patients. Conclusions SLE patients with long disease duration, history of glucocorticoid use, age > 50 years and coronary artery disease are high-risk population for osteoporosis.