不同剂量糖皮质激素维持治疗对系统性红斑狼疮患者骨代谢影响的研究  

Study of the Effect of Different Doses of Glucocorticoid Maintenance Therapy on Bone Metabolism in Patients with Systemic Lupus Erythematosus

作　　者：梁灼源[1] 韦锋[1] 欧阳楚君[1] 冯明亮[1] LIANG Zhuoyuan;WEI Feng;OUYANG Chujun;FENG Mingliang(Jiangmen Central Hospital,Jiangmen 529000,China)

机构地区：[1]江门市中心医院,广东江门529000

出　　处：《中外医学研究》2022年第2期43-47,共5页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:观察不同剂量糖皮质激素维持治疗对系统性红斑狼疮(SLE)患者骨代谢的影响。方法:回顾性分析2016年12月-2019年12月江门市中心医院收治的93例SLE患者的临床资料。根据注射用甲泼尼龙琥珀酸钠使用剂量不同将患者分为小剂量、中剂量、大剂量组,各31例。给予注射用甲泼尼龙琥珀酸钠剂量为小剂量组<0.5 mg/(kg·d),中剂量组0.5~1.0 mg/(kg·d),大剂量组第1~3天4.0~8.0 mg/(kg·d),然后调整剂量到1.0 mg/(kg·d),继续治疗4 d。连续治疗6个月后,比较三组治疗前后腰椎、股骨及Ward三角区骨矿含量和骨密度,血清甲状旁腺素(PTH),血钙含量及骨损伤发生率。结果:三组治疗前腰椎、股骨及Ward三角区骨矿含量及骨密度,PTH及血钙含量比较差异均无统计学意义(P>0.05);治疗后,小剂量组治疗前后腰椎、股骨和Ward三角区骨矿含量及骨密度比较差异均无统计学意义(P>0.05),中剂量组及大剂量组腰椎、股骨和Ward三角区骨矿含量及骨密度均低于治疗前(P<0.05),中剂量组及大剂量组腰椎、股骨和Ward三角区骨矿含量及骨密度均低于小剂量组(P<0.05),且随着糖皮质激素剂量增加,腰椎、股骨和Ward三角区骨矿含量及骨密度呈现下降趋势(P<0.05);小剂量组PTH及血钙含量治疗前后比较差异均无统计学意义(P>0.05),中剂量组及大剂量组PTH水平均高于治疗前,血钙含量低于治疗前(P<0.05),中剂量组及大剂量组PTH水平均高于小剂量组,血钙含量低于小剂量组(P<0.05),且随着糖皮质激素剂量增加,PTH水平呈现上升趋势,血钙含量呈现下降趋势(P<0.05);大剂量组骨损伤发生率高于小剂量组(P<0.05),大剂量组与中剂量组,中剂量组与小剂量组骨损伤发生率比较差异均无统计学意义(P>0.05)。结论:不同剂量糖皮质激素维持治疗对SLE患者骨代谢的影响有所不同,且剂量越高,其骨矿含量和骨密度降低更多,且最终的骨损伤发生率更高。Objective:To observe the effect of Glucocorticoid maintenance therapy with different doses on bone metabolism in patients with systemic lupus erythematosus(SLE).Method:The clinical data of 93 patients with SLE treated in Jiangmen Central Hospital from December 2016 to December 2019 were retrospectively analyzed.They were divided into low-dose,medium-dose and high-dose groups according to different doses of Methylprednisolone Sodium Succinate for Injection,with 31 patients in each group.The dosage of Methylprednisolone Sodium Succinate for Injection in low-dose group was<0.5 mg/(kg·d),medium-dose group was 0.5-1.0 mg/(kg·d)and high-dose group was 4.0-8.0 mg/(kg·d)on the first to third day,and then adjusted to 1.0 mg/(kg·d)for continued treatment of 4 d.After 6 months of continuous treatment,bone mineral content and bone mineral density in lumbar vertebra,femur and Ward triangle,serum parathyroid hormone(PTH),blood calcium content before and after treatment and incidence of bone injury were compared among the three groups.Result:There were no significant differences in bone mineral content and bone mineral density in lumbar vertebra,femur and Ward triangle,PTH and blood calcium content before treatment among three groups(P>0.05).After treatment,there were no significant differences in bone mineral content and bone mineral density in lumbar vertebra,femur and Ward triangle before and after treatment in the low-dose group(P>0.05),and the bone mineral content and bone mineral density in lumbar vertebra,femur and Ward triangle in medium-dose group and high-dose group were lower than those before treatment(P<0.05),and the bone mineral content and bone mineral density in lumbar vertebra,femur and Ward triangle in medium-dose group and high-dose group were lower than those in low-dose group(P<0.05).With the increase of Glucocorticoid dose,the bone mineral content and bone mineral density in lumbar vertebra,femur and Ward triangle decreased(P<0.05).There were no significant differences in PTH and blood calcium content

关 键 词：系统性红斑狼疮 糖皮质激素 不同剂量 骨代谢 

分 类 号：R593.241[医药卫生—内科学]