系统性红斑狼疮缓解期患者长期服用小剂量泼尼松对骨密度的影响  

The effect of long-term low dose prednisone on bone mineral density in patients with systemic lupus erythematosus

作　　者：王钢[1] 李向培[1] 厉小梅[1] 汪国生[1] 陶金辉[1] 马艳[1] 

机构地区：[1]安徽医科大学附属省立医院风湿免疫科,合肥230001

出　　处：《中华内科杂志》2017年第3期179-183,共5页Chinese Journal of Internal Medicine

基　　金：国家自然科学基金（81373186）

摘　　要：目的研究长期服用小剂量泼尼松对缓解期系统性红斑狼疮（SLE）患者骨密度的影响。方法选长期服用小剂量泼尼松的女性缓解期SLE患者118例，同时选年龄、性别、BMI相匹配的健康对照者29例。采用双能X线吸收法测所有受试者骨密度，分析骨密度与病程及泼尼松剂量的相关性。结果118例女性缓解期SLE患者中骨量减少50例（42.4%），骨质疏松17例（14.4%）。股骨颈、股骨、桡骨远端、桡骨、腰椎（L2～4）的骨密度口服泼尼松≤7.5 mg/d SLE患者[（0.897±0.116） g/cm2，（0.931±0.115） g/cm^2，（0.366±0.058） g/cm^2，（0.523±0.054） g/cm^2，（1.052±0.143） g/cm^2]、泼尼松7.5～10 mg/d者[（0.871±0.138） g/cm^2, （0.935±0.143） g/cm^2, （0.358±0.055） g/cm^2, （0.515±0.056） g/cm^2, （1.056±0.140）g/cm^2]均低于健康对照者[（1.020±0.107） g/cm^2, （1.081±0.129） g/cm^2, （0.393±0.524） g/cm^2, （0.556±0.050） g/cm^2, （1.239±0.114）g/cm^2，P〈0.05]。SLE病程≤3年者、SLE病程4～5年者、SLE病程6～10年者、SLE病程〉10年者上述检测部位的骨密度均低于健康对照者（P〈0.05），SLE病程〉10年者上述检测部位的骨密度均低于SLE病程≤3年者、SLE病程4～5年者、SLE病程6～10年者（P〈0.05）。多因素logistic回归分析显示，累积泼尼松剂量与骨量减少相关（OR＝1.069，95% CI 1.008～1.133，P＝0.025），补充钙剂（OR＝0.343，95% CI 0.135～0.868，P＝0.024）、阿法骨化醇（OR＝0.320，95% CI 0.112～0.913，P＝0.033）是骨密度的保护性因素。结论缓解期SLE患者长期服用小剂量泼尼松导致不同程度的骨密度减低，以腰椎和股骨颈的发生率最高。长期应用泼尼松≤7.5 mg/d也导致骨密度明显减低。补充钙剂、阿法骨化醇是骨密度的保护性因素。Objective To investigate the effect of long-term low dose prednisone administration on bone mineral density （BMD） in patients with inactive systemic lupus erythematosus （SLE）. Methods A total of 118 inactive female SLE patients with long-term administration of low dose prednisone were recruited from the Department of Rheumatology and Immunology at An hui Provincial Hospital. All patients were given low dose prednisone for long-term （ ≤ 10 mg/d, more than half a year）. According to prednisone doses, subjects were divided into two groups, namely group A （ ≤7.5 mg/d） and group B （7.5 - 10 mg/d）. In addition, patients were also divided into four groups based on the duration of administration, including group Ⅰ ≤3 years, Ⅱ from 4 - 5 years, Ⅲ 6 - 10 years and Ⅳ 〉 10 years. Twenty-nine healthy people were recruitedas normal controls. The BMD was measured by dual energy X-ray absorptiometry. The association of BMD with prednisone dose and duration was compared between different groups. Results The incidence of osteopenia in all patients with SLE was 42. 4% （50/118）, and the incidence of osteoporosis was 14. 4% （17/118）. BMD of all bone sites in both group A and B were significantly lower than that in normal control group （P 〈 0. 05 ）. Similarly, the BMD of all bone sites in group Ⅰ , Ⅱ ,Ⅲ and Ⅳ were significantly decreased （P 〈 0. 05 ）. What needed to be stressed was the BMD in group Ⅳ was lower than those in other three groups （ P 〈 0. 05 ）. Multiple logistic regression analysis showed that the cumulative prednisone dose was the risk factor for osteopenia, while taking calcium and alfacalcidol were protective factors. Conclusion Long-term use of low dose prednisone result in the decrease of BMD in patients with inactive SLE. The lumbar spine and femoral neck had more severe osteopenia. Long-term administration of prednisone, even less than 7.5 rag/d, can also cause osteopenia. Calcium and alfacalcidol were protective factors of BMD.

关 键 词：红斑狼疮 系统性 泼尼松 骨密度 骨质疏松 

分 类 号：R593.241[医药卫生—内科学]