系统性红斑狼疮合并症状性膝关节骨梗死的临床特点分析  

Clinical characteristics of systemic lupus erythematosus combined with symptomatic knee osteonecrosis

作　　者：田娟 蒲丹[1] 胡楠 王妍华[1] 黄婧 莫凌菲[1] 罗静[1] 何岚[1] TIAN Juan;PU Dan;HU Nan;WANG Yanhua;HUANG Jing;MO Lingfei;LUO Jing;HE Lan(Department of Rheumatology and Immunology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院风湿免疫科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2021年第6期892-896,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家自然科学基金资助项目(No.81671629,81970029)。

摘　　要：目的分析系统性红斑狼疮(systemic lupus erythematosus, SLE)合并症状性膝关节骨梗死(knee osteonecrosis,KON)患者的临床特点及危险因素。方法回顾性分析西安交通大学第一附属医院风湿免疫科2013年4月至2019年12月收治的26例SLE合并KON患者的临床特点。结果 26例中,女性24例,男性2例,KON诊断年龄(35.3±9.0)岁,病程(48.7±35.1)个月,激素累积使用时间(37.8±42.7)个月,甲泼尼龙折合成最高日剂量(197.7±290.7)mg,累积使用剂量(6.02±6.66)g,其中6例有激素冲击史。26例均有免疫抑制剂使用史。SLE起病时狼疮疾病活动度(SLEDAI)评分为(11.23±5.46)分,发生KON时SLEDAI评分为(4.46±4.81)分。最常见的起病症状为浮肿及关节肿痛,最常见的系统损害为血液系统损害及狼疮性肾炎。最常见的免疫学异常为抗核抗体阳性(25/26)、抗SSA/Ro52 kD抗体阳性(16/26)和抗SmD1抗体阳性(15/26)。抗心磷脂抗体(anticardiolipin antibody, ACA)阳性者4例。骨代谢特点表现为血清维生素D3缺乏,N-端骨钙素不足,β-Ⅰ型胶原羧基端肽升高。26例中有9例合并股骨头坏死;12例发生多灶性(≥3处)骨梗死,多灶性骨梗死患者起病时系统损害更重,初始及累积使用激素剂量更大,ACA阳性率更高。结论 KON多发生于SLE病史3~4年后,多见于疾病活动度高、治疗过程中激素使用剂量大、时间长者。多灶性骨梗死多发,易见于病情重、激素最高日剂量大、累积剂量大及ACA阳性患者。Objective To investigate the clinical characteristics and risk factors of systemic lupus erythematosus(SLE)combined with symptomatic knee osteonecrosis(KON). Methods We retrospectively analyzed the clinical data of 26 cases of SLE with KON treated in the Department of Rheumatology and Immunology, The First Affiliated Hospital of Xi’an Jiaotong University, from April 2013 to December 2019. Results The age of the 26 patients(2 males and 24 females)was(35. 3±9. 0)years old at the diagnosis of KON,and the course of SLE was(48. 7±35. 1)months. The time from glucocorticoids initiation to the development of KON was(37. 8±42. 7) months, the maximum dosage of methylprednisolone was(197. 7±290. 7)mg and the cumulative dosage was(6. 02±6. 66)g. Six of the patients had a history of large-dose glucocorticoids impulse therapy. All of them had a history of immunosuppressant treatment. SLEDAI score was(11. 23±5. 46)at the onset of SLE and(4. 46±4. 81)at the onset of KON. The most common initial symptoms were edema and arthritis. The most common systemic damages were blood system damage and lupus nephritis. The most common immunological abnormalities were positive antinuclear antibody(25/26), positive anti-SSA/Ro52kD antibody(16/26),and positive anti-SmD1 antibody(15/26). There were 4 patients with positive anticardiolipin antibody(ACA).Bone metabolism was characterized by vitamin D3(Vit-D3)deficiency,insufficient N-terminal osteocalcin(N-OST),and increased β-C-terminal telopeptide of type Ⅰ collagen(β-CTx). In 9 out of the 26 patients,SLE was combined with aseptic necrosis of the femoral head. Multifocal bone necrosis(at least 3 lesions)was common(12/26). Longer disease course and glucocorticoids using time, larger cumulative dose and ACA positive were seen in patients with multifocal bone necrosis compared with those who had one lesion site. Conclusion KON most possibly occurs 3 to 4 years after the diagnosis of SLE, which is associated with high disease activity, large hormone dose, and long duration in the treatm

关 键 词：骨梗死 系统性红斑狼疮 多灶性骨梗死 膝关节 临床特点 

分 类 号：R593.24[医药卫生—内科学]