系统性红斑狼疮合并骨坏死的临床特点及骨密度结果分析  

Analysis of clinical features and bone mineral density in patients with systemic lupus erythematoms and osteonecrosis

作　　者：郭娟 周惠琼 张清 徐鹏慧 卢敏辉 叶彬 孔祥艳 GUO Juan;ZHOU Huiqiong;ZHANG Qing;XU Penghui;LU Minhui;YE Bin;KONG Xiangyan(Rheumatology Department of the Fourth Medical Center of the General Hospital of the Chinese People’s Liberation Army(PLA),Beijing 100048,China)

机构地区：[1]中国人民解放军总医院第四医学中心风湿科,北京100048

出　　处：《中国骨质疏松杂志》2020年第3期403-406,411,共5页Chinese Journal of Osteoporosis

摘　　要：目的分析系统性红斑狼疮(SLE)合并骨坏死的临床特点、治疗转归及与骨密度的相关性,以期早期诊断、及时干预。方法选取中国人民解放军总医院第四医学中心风湿科住院SLE合并骨坏死的患者作为研究对象,收集临床资料、骨密度结果及受累关节的核磁共振成像结果并进行相关分析。结果14例SLE合并骨坏死的患者占本院SLE住院患者的15%,12例女性,2例男性,中位发病年龄35岁,发生骨坏死时SLE的平均病程为61个月,骨坏死出现症状至确诊时间1~17周,平均8周,发生骨坏死时SLE疾病活动度平均3分。肾脏、关节、血液系统受累者易合并骨坏死。14例患者中12例患者骨坏死为多发,股骨头坏死与膝关节坏死发生率相同。8例骨量低下患者中7例出现股骨头坏死,4例骨质疏松患者中出现3例膝关节骨坏死,2例骨量正常患者大剂量激素冲击治疗后出现膝关节坏死。结论SLE患者合并骨坏死不少见,住院患者股骨头、膝关节发生率相当,应关注SLE合并膝关节骨坏死;肾脏、关节、血液系统受累、骨密度下降和长期应用糖皮质激素治疗患者易发生骨坏死。Objective To analyze the clinical features,bone mineral density(BMD),and the treatment and prognosis of systemic lupus erythematosus(SLE)with osteonecrosis(ON),in order to make early diagnosis and timely intervention.Methods The SLE patients with ON in the rheumatology department of the Fourth Medical Center of the General Hospital of the PLA were enrolled.The clinical data,BMD result,and the magnetic resonance imaging result of the involved joints were collected and analyzed.Results Fourteen SLE patients developed ON,which constituted 15%of SLE hospitalized patients.Twelve patients were females.Patients developed ON with a median age of 35 years.The mean duration of SLE was 61 months when osteonecrosis occurred.The interval from the onset of symptoms to diagnosis was 1 to 17 weeks.The mean SLE disease activity index(SLEDAI)was 3 points in ON patients.ON was common in patients with kidney,joints,and blood system involvement.Twelve patients had multiple ON.The incidence of ON of the femoral head(ONF)was equal to that of ON of the knee(ONK).Among 8 patients with osteopenia,7 patients developed ONF.Among 4 patients with osteoporosis,3 developed ONK.Two patients with normal BMD developed ONK after corticosteroids pulse therapy.Conclusion ON is not uncommon in SLE patients.The incidence of ONF and ONK is similar in hospitalized patients.Patients with kidney,joint,and blood system involvement,low BMD,and long-term glucocorticoid therapy are prone to develop ON.

关 键 词：系统性红斑狼疮 股骨头骨坏死 膝关节骨坏死 骨密度 

分 类 号：R593.24[医药卫生—内科学]