短期小剂量激素治疗对男性强直性脊柱炎患者骨代谢及骨密度的影响

目的：探讨短期应用小剂量糖皮质激素（GCs）对男性强直性脊柱炎（AS）患者骨代谢及骨密度的影响。方法：46例男性AS患者分为常规治疗组（22例,予免疫抑制剂＋非甾体抗炎药）和GCs组（24例,在常规治疗基础上加用小剂量激素）,检测2组治疗6个月前后血清骨保护素（OPG）、巨噬细胞-集落刺激因子（M-CSF）、血沉（ESR）、血清C反应蛋白（CRP）及BASDAI评分、骨密度（BMD）变化。结果：与治疗前比较,2组治疗后OPG水平显著升高（P〈0.05）;ESR、CRP、BASDAI评分显著降低（P〈0.05）;M-CSF水平亦降低,其中GCs组变化差异有统计学意义（P〈0.05）。治疗后2组间比较,OPG和M-CSF水平及BMD差异无统计学意义（P〉0.05）;ESR、CRP、BASDAI评分差异有统计学意义（P〈0.05）。结论：短期联合应用小剂量激素影响AS患者骨代谢指标及炎性指标,对BMD影响不大,其在AS治疗中是安全有益的。

Affection of short-term and low-dose glucocorticoid on bone mineral density and bone metabolism in the treatment of male patients with ankylosing spondylitis

Objective： Explore the change of bone mineral density and bone metabolism in male patients with ankylosing spondylitis by short-term and low-dose glucocorticoid.Methods： Randomly divide 46 patients into non-GC treatment group （22） and low-dose GC treatment group （24）. Non-GC treatment group receive DMARD and Ca, Low-dose GC treatment group receive low dose glucocorticoid as well as DMARD and Ca. The Serum levels of osteoprotegerin （OPG）, macrophage-colony stimulating factors （M-CSF）, erythrocyte sedi-mentation rate （ESR）, c-reactive protein （CRP）, bath AS disease activity index （BASDAI） and Bone mineral density （BMD） were measured at the baseline and 6 months after therapy.Results： Six months after treatment, the level of OPG increased signiifcantly （P〈0.05） and the level of ESR, CRP, BASDAI decreased signiifcantly （P〈0.05） in both groups respectively, compared with that at the baseline; the level of M-CSF of two treatment groups decreased, in which the low-dose GC treatment group did more signiifcantly （P〈0.05）. Six months after treatment, there was no signiifcant difference in the levels of OPG, M-CSF, and BMD （P〈0.05） between the two groups. There was signiifcant difference in the levels of ESR, CRP, BASDAI between the two groups （P〉0.05）. Conclusion： Short-term treatment of low-dose GC affect bone metabolisms and inlfamed index, while with no signiifcant inlfuence on BMD in AS patients. It is safe and beneift for AS patients.