系统性红斑狼疮并发骨坏死的相关因素分析  

Analysis of risk factors related to osteonecrosis in patients with systemic lupus erythematosus

作　　者：臧银善[1] 刘晓华[1] 张缪佳[1] 

机构地区：[1]南京医科大学附属第一医院风湿科,江苏南京210029

出　　处：《中国医刊》2007年第1期46-49,共4页Chinese Journal of Medicine

摘　　要：目的探讨系统性红斑狼疮并发骨坏死的影响因素。方法485例SLE患者中合并骨坏死者共40例,分为SLE-ON组。按1∶2比例随机选择有完整的病例资料的80例非骨坏死的SLE患者为对照组。采用病例—对照研究的方法,对各个研究因素采用逐步引入—剔除法,建立Logistic回归模型进行统计分析。结果单因素分析显示:Cush ing征、骨质疏松、血钙水平下降、高脂血症、抗磷脂抗体阳性、补体水平下降、疾病活动指数(SLEDAI2K)、激素累积剂量、日平均激素剂量、甲泼尼龙冲击与SLE合并骨坏死相关联(P<0.05或P<0.01);多因素分析显示,导致骨坏死的危险因素为:激素累积剂量(P=0.013)、日平均激素剂量(P<0.001)。结论SLE治疗过程中发生骨坏死的危险因子包括Cush ing征、骨质疏松、血钙水平下降、高脂血症、抗磷脂抗体阳性、补体水平下降、疾病活动指数(SLEDAI2K)、激素累积剂量、日平均激素剂量、甲泼尼龙冲击;其中激素累积剂量、日平均激素剂量是骨坏死发生的独立危险因素。SLE患者骨坏死的发生是应用糖皮质激素基础上多种因子的共同结果。Objective To determine the risk factors related to osteonecrosis （ON） in patients with systemic lupus erythematosus （SLE）. Methods A case-control study was conducted among 485 SLE patients, 40 of them with ON were included in the case group and the other 80 of them without ON were in the control group. A Logistic regression model was established and step-wise selection was used to analyze those different factors. Results Univariate analysis showed that Cushing-Syndrome, osteoporosis, hypocalcemia, hyperlipidemia, positive antipholipid antibody, low complements,disease activity index, accumulative dosage of glucocorticoid, mean daily steroid dose, and methylprednisolone pulse treatment were associated with ON（P 〈0.05 or P 〈0.01 ）. When compared with controls, SLE patients with ON had a significantly higher incidence. Multivariate analysis showed that accumulative dosage of glucocorticoid（ OR = 1. 0001,95% CI： 1. 000012 - 1. 000103 ,P = 0. 013 ）, and mean daily steroid dose （ OR = 1. 107,95% CI： 1. 056 - 1. l60,P 〈0.001 ） were significantly associated with ON. Conclusion The risk factors of ON during the induction therapy in SLE patients include Cushing-Syndrome, osteoporosis, hypocalcemia, hyperlipidemia, positive antipholipid antibody,low complements, disease activity index, accumulative dosage of glucocorticoid, mean daily steroid dose,and methylprednisolone pulse treatment. Accumulative dosage of glucocorticoid and mean daily steroid dose are independent risk factors. SLE patients with risk factors should be closely monitored so that early ON could be diagnosed.

关 键 词：红斑狼疮 系统性 骨坏死 危险因子 LOGISTIC回归模型 

分 类 号：R593.2[医药卫生—内科学]