糖皮质激素治疗的天疱疮患者骨质疏松现状分析

【摘要】 目的 探讨糖皮质激素治疗的天疱疮患者骨质疏松的发生率及相关危险因素，分析骨质疏松的预防和治疗现状。方法 收集2014年1月至2019年1月间在中国医学科学院皮肤病研究所住院治疗的101例天疱疮患者资料，根据骨密度值分为骨质疏松组（21例）和非骨质疏松组（80例）。分析患者的一般资料及糖皮质激素应用时间及累积量、免疫抑制剂应用、糖尿病、高血压、高脂血症、吸烟、户外活动等因素与骨质疏松的相关风险，同时分析钙剂、维生素D及双磷酸盐的应用情况。计数资料比较采用χ2检验，计量资料比较采用t检验，多因素分析采用非条件Logistic回归分析。结果 Logistic回归分析显示，年龄（P = 0.001，OR = 1.08，95% CI：1.03～1.14）、糖皮质激素累积量（P＜0.001，OR = 1.72，95% CI：1.18～2.52）是发生骨质疏松的高危因素，户外活动（P＜0.001，OR = 0.04，95% CI：0.01～0.21）是保护因素。骨质疏松组中13例（61.9%）、非骨质疏松组16例（21.6%）接受了钙剂、维生素D及双磷酸盐的联合治疗。结论 接受糖皮质激素治疗的天疱疮患者易伴发骨质疏松，高龄和糖皮质激素累积量是骨质疏松的危险因素，户外活动是保护因素。天疱疮患者骨质疏松的防治措施存在不规范。

Analysis of risk factors for osteoporosis in patients with pemphigus treated with systemic glucocorticoids

Objective To investigate the incidence of and risk factors for osteoporosis in patients with pemphigus treated with systemic glucocorticoids,and to analyze the current status of prevention and treatment of osteoporosis.Methods Clinical data were collected from 101 inpatients with pemphigus treated in Institute of Dermatology,Chinese Academy of Medical Sciences and Peking Union Medical College from January 2014 to January 2019,and these patients were divided into osteoporosis group(n=21)and non-osteoporosis group(n=80)according to their bone mineral density(BMD)values.Correlations of osteoporosis with patients′general information,treatment duration and cumulative dose of glucocorticoids,application of immunosuppressive agents,diabetes mellitus,hypertension,hyperlipidemia,smoking,outdoor activity and other factors were analyzed,and the application status of calcium supplements,vitamin D and bisphosphonates was also analyzed.Enumeration data were compared by using chi-square test,measurement data were compared by using t test,and multiple factors influencing osteoporosis were analyzed by using non-conditional Logistic regression analysis.Results Logistic regression analysis showed that age(P=0.001,OR=1.08,95%CI:1.03-1.14)and cumulative dose of glucocorticoids(P<0.001,OR=1.72,95%CI:1.18-2.52)were risk factors for the occurrence of osteoporosis,while outdoor activity(P<0.001,OR=0.04,95%CI:0.01-0.21)was a protective factor.Moreover,13(61.9%)patients in the osteoporosis group and 16(21.6%)patients in the non-osteoporosis group received combination treatment with calcium supplements,vitamin D and bisphosphonates.Conclusions Pemphigus patients treated with systemic glucocorticoids are prone to develop osteoporosis.Older age,cumulative dose of glucocorticoids may be risk factors for osteoporosis in patients with pemphigus,while outdoor activity may be a protective factor.The prevention and treatment of osteoporosis in pemphigus patients are still not standardized.