初发系统性红斑狼疮患者骨密度状态的临床研究  

Clinical analysis of bone mineral density in patients with newly diagnosed untreated systemic lupus erythematous

作　　者：李欣艺 邓晓莉[1] 李常虹[1] 刘湘源[1] Li Xinyi;Deng Xiaoli;Li Changhong;Liu Xiangyuan(Department of Rheumatology and Immunology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院风湿免疫科,100191

出　　处：《中华风湿病学杂志》2020年第8期511-516,共6页Chinese Journal of Rheumatology

基　　金：国家自然科学基金(81501390)。

摘　　要：目的探讨初发SLE患者的骨密度状态及与临床指标之间的关系。方法选取2014—2018年在北京大学第三医院风湿免疫科住院治疗的初发SLE患者纳入此横断面研究,同时纳入年龄匹配的健康者作为对照组。所有入组患者在治疗前均通过双能X线吸收法检测腰椎及双髋关节骨密度。收集患者包括骨密度在内的临床数据。根据骨密度值将患者分组为骨密度正常组、骨密度减低组。组间计量资料采用Student-t检验、Mann-Whitney U检验,分类统计资料采用χ2检验。结果共89例符合条件初发SLE患者、20名健康者纳入研究,约52.8%(47例)初发SLE患者存在骨密度减低。初发SLE患者的腰椎骨密度和髋关节骨密度低于健康者[(0.97±0.14)g/cm2,(1.08±0.10)g/cm2,t=3.548,P<0.01;(0.88±0.15)g/cm2,(1.00±0.08)g/cm2,t=3.878,P<0.01]。初发SLE患者骨密度减低组腰椎及髋关节骨密度低于骨密度正常组[(0.88±0.10)g/cm2,(0.80±0.11)g/cm2;(1.07±0.11)g/cm2,(0.97±0.13)g/cm2]。与骨密度正常组相比,骨密度减低组患者的BMI减低[(19.2±2.0)kg/m2和(23.2±3.6)kg/m2,t=3.678,P<0.01],病程相对更长[(45.7±7.7)周和(16.0±19.5)周,t=-3.306,P<0.01]。此外,骨密度减低组患者存在低25羟维生素D3(25-OH-VD3)[(9±5)nmol/L和(12±7)nmol/L,t=1.385,P>0.05],高骨代谢标志物水平(B胶原降解产物)[0.62(0.21,1.61)ng/ml和0.43(0.19,0.88)ng/ml,Z=0.624,P>0.05]等特点,差异无统计学意义。结论初发SLE患者的骨密度较健康患者的低,其中约52.8%存在骨密度减低。此部分患者存在低BMI、长病程特点。与骨密度正常的初发SLE组相比,骨密度减低的初发SLE组患者的25-OH-VD3水平呈减低趋势,其骨代谢标志物水平更高,虽然目前研究未见明显统计学差异,但对临床有一定提示意义。Objective The study was aimed to investigate the bone mineral density(BMD)status of newly diagnosed systemic lupus erythematous(SLE)patients.Methods Newly diagnosed SLE patients and healthy controls in Peking University Third Hospital from 2014 to 2018 were enrolled into this cross-sectional study.Medical records including systemic lupus erythematosus disease activity index(SLEDAI)-2000 and BMD of the lumbar vertebrae and hips measured by dual-energy X-ray absorptiometry were collected.Patients were divided into normal and low BMD groups.Parameters were compared by Student-t test,Mann-Whitney U test andχ2 test.Results Eighty-nine patients and 20 healthy controls were included.Approximately 52.8%of the SLE patients had low BMD.Compared to the healthy control group,the BMD of lumbar spine and hip was obviously lower than in the newly diagnosed SLE group[(0.97±0.14)g/cm2,(1.08±0.10)g/cm2,t=3.548,P<0.01;(0.88±0.15)g/cm2,(1.00±0.08)g/cm2,t=3.878,P<0.01].The BMD of lumbar spine and hip in the low BMD group was lower than that in the normal BMD group[(0.88±0.10)g/cm2,(0.80±0.11)g/cm2;(1.07±0.11)g/cm2,(0.97±0.13)g/cm2,respectively].Compared with the normal BMD group,the body mass index(BMI)was significantly lower[(19.2±2.0)kg/m2,(23.2±3.6)kg/m2 respectively,t=3.678,P<0.01],the disease duration was longer[(45.7±7.7)weeks,(16.0±19.5)weeks,respectively,t=-3.306,P<0.01).Patients with low BMD tended to have lower 25-hydroxy-vitamin-D(25-OH-VD3)level and higher bone metabolism marker levels(Degradation products of collagen B)[(9±5)nmol/L vs(12±7)nmol/L,t=1.385,P>0.05;0.62(0.21,1.61)ng/ml vs 0.43(0.19,0.88)ng/ml,Z=0.624,P>0.05],although their differences didn't reach the statistical significant difference.Conclusion Newly diagnosed SLE patients'BMD is lower than the healthy people.About 52.8%newly diagnosed untreated SLE patients have low BMD.Lower BMI and longer disease duration are their clinical characteristics.High bone metabolism marker levels,low 25-hydroxy-vitamin-D level might have clinical significance,a

关 键 词：红斑狼疮 系统性 骨 密度 未诊治 

分 类 号：R593.241[医药卫生—内科学]