狼疮患者骨质疏松和脆性骨折的危险因素包括慢性肾衰、抗凝和抗癫痫药使用

作者：Carli L, et al.

翻译：北医三院海淀院区费雅楠

摘要: 骨质疏松症（OP）和脆性骨折（FFX）是一种已知的系统性红斑狼疮（SLE）的合并症。这项工作的目的是评估（1）一组SLE患者队列中OP和FFX的患病率（2）与OP和FFX的相关危险因素。以下数据来自临床图表：收集年龄、性别、绝经状态（MP）、体质量指数、吸烟习惯、疾病持续时间、糖皮质激素（GCS）的每日剂量和累积剂量、器官受累的类型、合并症和药物。对骨代谢数据、钙和维生素D的补充和双磷酸盐治疗，特立帕肽或地舒单抗应用的情况也进行收集，骨密度（BMD）值（用双能X线骨密度仪（DXA）测量）和历史有无FFX发生（在SLE发病后并且与创伤无关）。根据WHO的标准定义骨质疏松症和骨量减少。186例患者（女性175例，男11例，平均年龄46.4+/ - 13岁，平均病程14.9 +/ - 9年）。在他们的最后一次访视中，97例（52.2%）有骨密度降低和52例（27.9%）有骨质疏松症。22例（11.8%）患者，所有均为女性，至少有一处FFX；6例（27.3%）患者在绝经前。单因素分析显示，年龄、糖皮质激素的累积剂量、绝经状态、抗癫痫药物治疗和慢性肾衰竭（CRF）与骨质疏松症相关（P＜0.03）；年龄、糖皮质激素的总剂量、绝经状态、慢性肾衰竭、抗凝（AC）和抗癫痫治疗与脆性骨折相关（P＜0.05）。多因素Logistic回归模型证实了骨质疏松症和年龄、绝经状态和抗癫痫治疗直接相关（P < ="0.01）；FFX与年龄、绝境状态、抗凝和抗癫痫药物长期治疗直接相关（P＜0.03）。总之，低骨量在系统性红斑狼疮患者经常发生，而且脆性骨折在绝经前患者中也观察到了。与传统的危险因素（年龄、绝经状态和糖皮质激素）相比，慢性肾功能衰竭、抗凝和抗癫痫的长期治疗似乎也与骨质疏松症和脆性骨折发生的风险增高有关。

附原文:Osteoporosis (OP) and fragility fractures (FFx) are a known comorbidity in patients with systemic lupus erythematosus (SLE). This work aimed at evaluating (1) the prevalence of OP and FFx in a cohort of SLE and (2) the risk factors associated with both OP and FFx. The following data were collected from clinical charts: age, sex, menopausal status (MP), body mass index, smoking habits, disease duration, daily dose and cumulative glucocorticoids (GCs), type of organ involvement, comorbidities and medications. Data on bone metabolism, calcium and vitamin D supplementation and treatment with bisphosphonates, teriparatide or denosumab were collected, together with bone mineral density (BMD) values( measured by dual-energy X- ray absorptiometry (DXA)) and history of FFx ( occurred after the onset of SLE and unrelated to trauma). OP and reduced BMD were defined according to the WHO. 186 patients were included (women 175, men 11; mean age 46.4+/-13 years, mean disease duration 14.9+/-9 years). At their last visit, 97 patients (52.2%) had a reduced BMD and 52 (27.9%) had OP. 22 patients (11.8%), all women, had at least one FFx; six patients (27.3%) were pre- menopausal. On univariate analysis, age, cumulative dose of GC, MP, therapy with antiepilepticsand chronic renal failure (CRF) were correlated with OP (p<0 .03); age, total amount of gc, mp, crf, anticoagulants (ac) and antiepileptictherapy were correlated with ffx (p<0.05). the multivariate logistic model confirmed a direct association of op and age, mp and antiepileptictherapy (p <="0.03);a" direct association of ffx and age, mp and chronic therapy with ac and antiepileptics (p<0.03). in conclusion, low bmd is frequently observed in sle, and ffx are observed also in premenopausal patients. together with traditional risk factors (age, mp and gc), crf and chronic treatments with ac or antiepileptics seem to be associated with a higher risk profile for op and ffx occurrence.

引自：Carli L, et al. Risk factors for osteoporosis and fragility fractures in patients with systemic lupus erythematosus.Lupus Sci Med.2016V3N1 :e000098