中国系统性红斑狼疮伴发骨坏死相关因素的Meta分析  

Relative factors for osteonecrosis in the Chinese systemic lupus erythematosus patients: Meta-analysis

作　　者：罗正亮[1] 尚希福[1] 李旭[1] 胡飞[1] 贺瑞[1] 

机构地区：[1]安徽医科大学附属省立医院骨科,安徽省合肥市230001

出　　处：《中国组织工程研究》2013年第35期6314-6320,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:系统性红斑狼疮是一种异质性疾病,除长期应用激素可引起骨坏死外,有研究指出临床表现的差异性也有可能是骨坏死的危险因素。目前国内外学者对在系统性红斑狼疮患者中发生骨坏死的致病因素存在不同观点。目的:对国内系统性红斑狼疮患者并发骨坏死的危险因素进行系统分析。方法:检索中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBMdisc)、万方数据库获得已公开发表的国内系统性红斑狼疮并发骨坏死相关危险因素的病例对照研究文献,筛选出符合评价标准的文献,采用RevMan5.0及Stata软件进行Meta分析,并计算各危险因素的合并比值比及95%置信区间。结果与结论:共纳入10篇病例对照研究,累计病例组332例、对照组986例。系统性红斑狼疮并发骨坏死的各危险因素的比值比及95%置信区间分别为:雷诺现象3.28(1.69-6.38),口腔溃疡2.95(2.13-4.09),肾脏受累1.21(0.83-1.74),血管炎因素5.64(2.84-11.21),高脂血症5.11(3.10-8.42),抗磷脂抗体2.32(1.49-3.61),关节受累2.02(1.33-3.07)。提示激素应用明确为系统性红斑狼疮并发骨坏死的独立危险因素,但并非惟一因素,血管炎、高脂血症、雷诺现象、口腔溃疡、抗磷脂抗体阳性及关节受累均为需要重视的国内系统性红斑狼疮患者并发骨坏死的危险因素。BACKGROUND： Systemic lupus erythematosus is a kind of heterogeneous disease, and the difference of clinical features may also be the risk factors of osteonecrosis besides of treatment with glucocorticoids according to the literature. However, it remains controversial on the risk factors of osteonecrosis in systemic lupus erythematosus patients. OBJECTIVE： To systematically review the major risk factors of osteonecrosis in the Chinese patients with systemic lupus erythematosus. METHODS： The CNKI database, CBMdisc database and Wanfang database were retrieved for the published case-control study literatures on the risk factors of osteonecrosis in the Chinese patients with systemic lupus erythematosus. The literatures met the inclusion and exclusion criteria were included, and a Meta-analysis was conducted by RevMan 5.0 and Stata software. Then, the pooled odd ratio and 95% confidence interval of each risk factor were calculated. RESULTS AND CONCLUSION： Ten case-control study literatures were included involving 332 cases in the case group and 986 cases in the control group. The pooled odd ratio and 95% confidence interval of each risk factor of osteonecrosis in the Chinese patients with systemic lupus erythematosus were as follows： Raynaud＇s phenomenon 3.28（1.69-6.38）, dental ulcer 2.95（2.13-4.09）, renal involvement 1.21（0.83-1.74）, vasculitis5.64（2.84-11,21）, hyperlipidemia 5.11（3.10-8.42）, anti-phospholipid antibody 2.32（1.49-3.61） and joints involvement 2.02（1.33-3.07）. It has been clear that the giucocorticoids is an independent risk factor of osteonecrosis in the patients with systemic lupus erythematosus. However, it is not the one and only risk factor. The following risk factors of vasculitis, hyperlipidemia, Raynaud＇s phenomenon, dental ulcer, positive anti-phospholipid antibody and joints involvement are the risk factors of osteonecrosis in the patients with systemic lupus erythematosus.

关 键 词：骨关节植入物 骨与关节循证医学 系统性红斑狼疮 骨坏死 危险因素 激素 血管炎 高脂血症 雷诺现象 病例对照研究 META分析 

分 类 号：R318[医药卫生—生物医学工程]