系统性红斑狼疮并发无菌性骨坏死与糖皮质激素使用相关性的荟萃分析  

Relationship between avascular necrosis in systemic lupus erythematosus patients and corticosteroid therapy:a Meta-analysis

作　　者：朱亚男 张文 ZHU Ya-nan;ZHANG Wen(Departments of Rheumatology and Clinical Immunology,Peking Union Medical College Hospital,Chinese Academy of Medical Science ＆ Peking Union Medical College,Key Laboratory of Rheumatology and Clinical Immunology,Ministry of Education,100730 Beijing,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院风湿免疫科,风湿免疫病学教育部重点实验室,北京100730

出　　处：《中华临床免疫和变态反应杂志》2018年第2期178-184,共7页Chinese Journal of Allergy & Clinical Immunology

基　　金：国家自然科学基金(81373190、81571587)~~

摘　　要：目的对系统性红斑狼疮(SLE)患者并发无菌性骨坏死(AVN)的发生率与糖皮质激素用法的相关性进行荟萃分析。方法检索PubMed、Embase、CBM、CNKI数据库中已公开发表的关于SLE并发AVN与糖皮质激素使用之间关系的病例对照研究文献,筛选出符合条件的文献,用Rev Man 5. 3统计学软件评估各文献间的同质性,同质性好的合并效应量分析采用固定效应模型,同质性不好的合并效应量采用随机效应模型进行分析。结果共纳入相关文献12篇,累计病例组总样本量450例,对照组总样本量1 092例。糖皮质激素冲击疗法(OR=1. 65,95%CI=1. 20～2. 27,P=0. 002)、起始糖皮质激素用量(MD=5. 17,95%CI=2. 40～7. 94,P=0. 002)、1个月累积糖皮质激素用量(SMD=0. 23,95%CI=0. 05～0. 41,P=0. 01)与SLE并发AVE明显有关,总累积糖皮质激素用量(SMD=0. 28,95%CI=-0. 01～0. 57,P=0. 06)和平均糖皮质激素用量(SMD=0. 27,95%CI=-0. 02～0. 56,P=0. 07)与SLE并发AVE无明显相关。结论糖皮质激素冲击疗法及短期大剂量糖皮质激素使用是SLE并发AVN的危险因素。Objective To investigate the relationship between avascular necrosis and corticosteroid therapy in systemic lupus erythematosus（ SLE） patients. Methods The Pub Med,Embase,CBM,CNKI were reviewed for the published case-control studies on the relationship between avascular necrosis in SLE patients and corticosteroid therapy. The studies all met inclusion and exclusion criteria,and the Rev Man 5. 3 software was used for Meta-analysis. Results Twelve trials were included,involving 450 patients in the case group and1 092 patients in the control group. The results showed that pulse methylprednisolone（ OR = 1. 65,95% CI =1. 20-2. 27,P = 0. 002）,initial prednisolone dose（ MD = 5. 17,95% CI = 2. 40-7. 94,P = 0. 0002）,and cumulative prednisolone dose in 1 month（ SMD = 0. 23,95% CI = 0. 05-0. 41,P = 0. 01） was associated with avascular necrosis in SLE patients while total cumulative prednisolone dose（ SMD = 0. 28,95% CI =-0. 01-0. 57,P = 0. 06） and mean prednisolone dose（ SMD = 0. 27,95% CI =-0. 02-0. 56,P = 0. 07） were not.Conclusion Methylprednisolone pulse injection and large dose of prednisolone in a short period are risks factors for avascular necrosis in SLE patients,but there is no relationship between total prednisolone dose,mean prednisolone dose and avascular necrosis in SLE patients.

关 键 词：系统性红斑狼疮 无菌性骨坏死 糖皮质激素 META分析 

分 类 号：R681[医药卫生—骨科学] R593.241[医药卫生—外科学]