长期服用激素的狼疮患者至少应服钙剂和骨化三醇预防骨质疏松

目的：为评价长期使用激素的系统性红斑狼疮患者服用钙剂、骨化三醇或阿仑膦酸盐的骨密度改变，主要研究终点是骨密度在2年后的改变。方法：绝经前的狼疮患者随机进入3组服药：碳酸钙（500mg,2/d）组、骨化三醇0.25ug/d加钙剂（500mg,2/d）组及阿仑膦酸盐（70mg/w）加钙剂（500mg,2/d）组，在基线和第1年及第2年末测定骨密度。结果：共98例患者参加了研究，其中仅服钙剂组、钙加骨化三醇组和阿仑膦酸盐加钙剂组分别为33例、33例和32例，平均使用激素2.5年（0-20年），其中77例患者（78.6%）完成了研究（其中三组分别为23例、27例和27例），测定骨密度时，3组的平均激素剂量无明显差别。2年后，除仅用钙剂组的全髋骨密度降低0.93%（p<0 .001）外，仅用钙剂组和钙加骨化三醇组的骨密度均无明显改变。相比而言，阿仑膦酸盐加钙剂组显示腰椎和全髋的骨密度均有明显增高，分别增高2.69%和1.41%（p均<0.001）。结论：单独使用钙及骨化三醇加钙剂可使长期用激素的绝经前女性狼疮2年后的腰椎骨密度稳定，而阿仑膦酸盐加钙剂能使腰椎和全髋骨密度增高，服用激素的绝经前妇女应考虑预防骨质疏松。

附原文：OBJECTIVE: To assess bone mineral density (BMD) changes in patients with systemic lupus erythematosus (SLE) undergoing longterm therapy with corticosteroids (CS) while taking calcium, calcitriol, or alendronate. The primary endpoint was BMD changes at 2 years. METHODS: Premenopausal SLE patients were randomized into 3 groups according to medication: calcium carbonate 500 mg bd (calcium alone), calcitriol 0.25 microg bd plus calcium carbonate 500 mg bd (calcitriol + calcium), and alendronate 70 mg/week plus calcium carbonate 500 mg bd (alendronate + calcium). BMD was measured at baseline and at the end of the first and second years. RESULTS: Ninety-eight patients were recruited. There were 33 patients taking calcium alone, 33 calcitriol + calcium, and 32 alendronate + calcium. On randomization, median duration of CS use was 2.5 years (range 0-20 yrs). Seventy-seven patients (78.6%) completed the study (23 taking calcium alone, 27 calcitriol + calcium, 27 alendronate + calcium). There were no significant differences in mean CS dosages among the 3 groups at the time of BMD measurements. After 2 years, there were no significant changes in BMD in the calcium-alone and calcitriol + calcium groups, apart from a 0.93% (p < 0.001) reduction in total hip bmd in the calcium-alone group. in contrast, the alendronate + calcium group showed significant increases in bmd of 2.69% (p < 0.001) in the lumbar spine and 1.41% (p < 0.001) in total hip. conclusion: both calcium alone and calcitriol + calcium preserved lumbar spine bmd in premenopausal patients with sle taking longterm cs at 2 years, whereas alendronate + calcium led to increases in bmd in lumbar spine and total hip. premenopausal women taking cs should be considered for osteoporosis prophylaxis.

[摘自：Yeap SS, Fauzi AR, Kong NC, et al. A Comparison of Calcium, Calcitriol, and Alendronate in Corticosteroid-Treated Premenopausal Patients with Systemic Lupus Erythematosus. J Rheumatol. 2008 Nov 1. [Epub ahead of print]]