不同剂量糖皮质激素维持治疗对系统性红斑狼疮患者骨密度及骨代谢的影响

发布时间：2018-02-03 10:01

本文关键词： 系统性红斑狼疮骨代谢骨质疏松激素　出处：《蚌埠医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的调查系统性红斑狼疮(SLE)患者临床与有关实验室检查特点,了解SLE患者骨密度的影响因素。检测SLE患者维持治疗阶段骨密度和血清骨特异性碱性磷酸酶(BAP)、抗酒石酸酸性磷酸酶5b(TRACP-5b),研究不同剂量糖皮质激素(GCs)对SLE患者骨密度及骨代谢的影响,探讨GCs诱发的骨质疏松(GIOP)防治策略。方法收集387例SLE患者及30例健康者临床及实验室资料,并应用美国产Hologic/discovery-W型双能X线骨密度仪检测其骨密度。将387例SLE患者分为骨质疏松(OP)/骨量减少组与骨量正常组,分析骨密度影响因素。从387例SLE患者中选择完善骨代谢指标者124例,包括初诊患者及治疗患者,初诊患者有20例,治疗患者104例,治疗患者均应用泼尼松维持治疗,2.5mg/d维持治疗者14例,5mg/d维持治疗者36例,7.5mg/d维持治疗者18例,10mg/d维持治疗者36例。结果统计分析387例SLE患者骨密度变化与GCs使用时间(P=0.001)、累积剂量(P0.001)、年龄(P=0.041)、病程(P=0.001)、绝经(P=0.005)、日照(P=0.002)差异有统计学意义。服用维D钙(P=0.004)、服用α骨化醇(P=0.012)是SLE患者发生骨量减少和骨质疏松的保护因素。与正常组比较,腰椎及股骨颈骨密度均从初诊组开始降低(P0.05);与初诊组比较,腰椎骨密度从5mg/d组开始降低,股骨颈骨密度从7.5mg/d组开始降低(P0.05)。腰椎骨密度与血清BAP、TRACP-5b呈负相关(P0.01);股骨颈骨密度与血清BAP、TRACP-5b呈负相关(P0.01)。与正常组比较,SLE患者血清BAP及TRACP-5b均从初诊组开始升高(P0.05);与初诊组比较,血清BAP及TRACP-5b均从5mg/d组开始升高(P0.05),血清BAP与系统性红斑狼疮疾病活动指数(SLEDAI)间呈正相关(r=0.286,p=0.001),TRACP-5b与SLEDAI间呈正相关(r=0.272,p=0.002)。结论 SLE患者骨代谢影响因素是多方面的,GCs在SLE骨质丢失中起重要作用,即使生理剂量的GCs也可导致骨量丢失,主要与GCs的使用时间、累积剂量和维持治疗剂量有关。5mg/d以上的维持剂量即可引起骨代谢增强,骨质流失;腰椎比股骨颈对激素更敏感。SLE疾病本身也可导致骨代谢增强,骨吸收增加,骨质流失,且活动期患者有较多的骨质流失。
[Abstract]:Objective to investigate the clinical and laboratory features of patients with systemic lupus erythematosus (SLE). Objective: to investigate the influencing factors of bone mineral density (BMD) in patients with SLE, and to detect the bone mineral density (BMD) and serum bone specific alkaline phosphatase (BAP) in patients with SLE during maintenance therapy. To study the effects of different doses of glucocorticoid on bone mineral density and bone metabolism in patients with SLE. Methods the clinical and laboratory data of 387 patients with SLE and 30 healthy controls were collected. The bone mineral density (BMD) was measured by American Hologic/discovery-W dual energy X-ray absorptiometry. 387 patients with SLE were divided into Osteoporosis and Osteoporosis (OPO). / bone mass reduction group and normal bone mass group. The influencing factors of bone mineral density (BMD) were analyzed. 124 cases were selected from 387 patients with SLE, including first diagnosis and treatment, 20 cases were first diagnosed and 104 cases were treated. All the patients were treated with prednisone maintenance therapy (2.5 mg / d). 14 patients with 5 mg / d were treated with prednisone, 36 patients with 7.5 mg / d were treated with prednisone maintenance therapy, 18 patients were treated with 2.5 mg / d maintenance therapy. Results the changes of bone mineral density (BMD) and the time of use of GCs in 387 patients with SLE were analyzed statistically. Age: P0. 041, course of disease P0. 001, menopausal P0. 005). The difference was statistically significant (P 0.002). Take vitamin D calcium (P0. 004). The protective factors of osteopenia and osteoporosis in SLE patients were compared with those in the normal group. The bone mineral density of lumbar vertebrae and femoral neck decreased from the first visit group. Compared with the newly diagnosed group, the bone mineral density of lumbar vertebrae began to decrease from 5 mg / d, and the bone density of femoral neck decreased from 7.5 mg / d to 7.5 mg / d. The bone mineral density of lumbar vertebrae and serum BAP began to decrease. TRACP-5b was negatively correlated with P0.01; The bone mineral density of femoral neck was negatively correlated with serum BAPCP-5b and compared with the normal group. The levels of serum BAP and TRACP-5b in patients with SLE were increased from the first visit group. Compared with the first visit group, the serum BAP and TRACP-5b increased from 5mg / d group to P0.05). There was a positive correlation between serum BAP and activity index of systemic lupus erythematosus (SLEDAI). There was a positive correlation between TRACP-5b and SLEDAI. Conclusion there are many factors influencing bone metabolism in SLE patients. GCs plays an important role in the bone loss of SLE. Even the physiological dose of GCs can lead to the loss of bone mass, which is mainly related to the use time of GCs. The cumulative dose and the maintenance dose were related to the maintenance dose of more than 0.5 mg / d, which could lead to the enhancement of bone metabolism and the loss of bone. Lumbar vertebrae is more sensitive to hormone than femoral neck. SLE disease itself can also lead to increased bone metabolism, bone resorption, bone loss, and more bone loss in active patients.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R593.241

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