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系统性红斑狼疮并发无菌性骨坏死的危险因素分析 |
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唐福林 金聂 吴敏 张红卫
【摘 要】 目的 探讨系统性红斑狼疮(SLE)无菌性骨坏死(AVN)与临床和实验室检查的关系。方法 统计本院发生无菌性骨坏死住院的29例SLE病人，同时随机抽样不伴有无菌性骨坏死的40例SLE和20例皮肌炎/多发性肌炎(DM/PM)病人作为对照组。分析性别、年龄、贫血、高血压、雷诺现象、血管炎、肾脏受累、抗磷脂抗体、柯兴征以及糖皮质激素用量和免疫抑制剂的应用与AVN发生的关系。结果 SLE＋AVN组的糖皮质激素治疗起始量1、3、4～6、7～12个月的剂量较SLE对照组大(P＜0.05～0.01)，而13～24个月期间两组糖皮质激素的用量无统计学差异；与不伴AVN的DM/PM组比较，上述各时期糖皮质激素用量均无差异。还发现，AVN的发生与年龄小、血管炎和较少应用免疫抑制剂相关。结论 糖皮质激素是SLE病人发生无菌性骨坏死的重要因素，但不是唯一因素。
【关键词】 红斑狼疮，系统性 骨坏死 危险因素
Risk factors for avascular necrosis of bone in patients with systemic lupus erythematosus
TANG Fulin JIN Nie WU Min,et al.
(Peking Union Medical College Hospital,Beijing 100730)
【Abstract】 Objective To study the clinical and laboratory factors in patients with systemic lupus erythematosus (SLE) and to identify the risk factors of avascular necrosis (AVN) of bone.Methods Twenty-nine SLE patients with AVN of bone,40 SLE patients and 20 polymyositis (PM)/dermatomyositis (DM) patients without AVN were selected randomly from the inpatient.The relationship between sex,age,anemia,hypertension,Raynaud′s phenomenon,vasculitis,renal involvement,anticardiolipin antibodies (ACL),Cushing syndrome,glucocorticosteroid dosage,immunosuppresive agents and AVN of bone was analysed.Results The patients with AVN had significantly greater glucocorticosteroid ingestion during the first 1,3,4～6,7～12 months of therapy than that of SLE patients without AVN (P＜0.05～0.01),but there was no difference between AVN group and PM/DM group,It was found that the occurrence of AVN is positively related with the existance of vasculitis and less use of immunosuppresive agents,and it is more common in younger SLE patients.Conclusion Glucocorticosteroid is an important risk factor inducing AVN in patients with SLE,but it is not the only factor.
【Key words】 Lupus erythematosus,systemic Osteonecrosis Risk factors
无菌性骨坏死(AVN)是系统性红斑狼疮(SLE)的常见并发症之一，其受累部位以股骨头多见。由于至今尚无有效的治疗方法，致残率高。大剂量糖皮质激素治[1] [2] 下一页
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