Kipen Y, Briganti E M, Strauss B J, Littlejohn G O, Morand E F
Department of Rheumatology, Monash Medical Centre, Monash University, Melbourne, Australia.
Rheumatology (Oxford). 1999 Jan;38(1):59-65. doi: 10.1093/rheumatology/38.1.59.
To measure the change in body composition in a pre-menopausal female systemic lupus erythematosus (SLE) population over 3 yr, and to identify predictors of change in body composition including the effects of disease-, corticosteroid (CS)- and patient-related variables.
All 55 pre-menopausal females with SLE who participated in a cross-sectional study of body composition in 1994 were invited to undergo interview, examination, medical record review, and body composition assessment by dual-energy X-ray absorptiometry (DXA).
Twenty-eight subjects participated with a mean (S.E.M.) age of 34.4 (1.6) yr, duration of SLE of 6.8 (0.8) yr and mean (range) time to follow-up of 3.2 (2.9-3.4) yr. Seventeen subjects were exposed to CS during the study period with a mean (range) daily dose of prednisolone of 12.0 (2.8-22.9) mg. There was a significant increase in body mass index (BMI) (24.53+/-0.83 vs 25.37+/-1.04, P = 0.03) and fat-free mass (41.04+/-0.83 vs 41.53+/-0.92, P = 0.05) over the 3 yr period. Univariate analysis revealed that change in fat-free mass was significantly associated with change in total body bone mineral density (BMD) (P = 0.03). Stepwise multiple linear regression analysis revealed a significant independent association of disease activity with increases in both BMI (r2 = 0.41, P = 0.006) and fat mass (r2 = 0.39, P = 0.007), and of exercise and Modified Health Assessment Questionnaire with an increase in fat-free mass (r2 = 0.51, P = 0.007). Age at SLE diagnosis and smoking were significant independent predictors for loss of total body BMD, while CS duration was predictive of an increase in total body BMD (r2 = 0.80, P < 0.0001).
In this SLE population, disease activity was predictive of deleterious changes in body composition, including increases in BMI and fat mass. Patient-related variables were also important predictors of body composition change with exercise independently predicting an increase in fat-free mass, and smoking predictive of loss of total body BMD. In contrast, CS-related variables were not found to have harmful effects on body composition. Change in fat-free mass, and not fat mass, was predictive of change in total body BMD.
测量绝经前女性系统性红斑狼疮（SLE）人群3年内身体成分的变化，并确定身体成分变化的预测因素，包括疾病、皮质类固醇（CS）和患者相关变量的影响。
邀请了所有55名参与1994年身体成分横断面研究的绝经前SLE女性接受访谈、检查、病历审查，并通过双能X线吸收法（DXA）进行身体成分评估。
28名受试者参与研究，平均（标准误）年龄为34.4（1.6）岁，SLE病程为6.8（0.8）年，平均（范围）随访时间为3.2（2.9 - 3.4）年。17名受试者在研究期间接受了CS治疗，泼尼松龙平均（范围）日剂量为12.0（2.8 - 22.9）mg。在3年期间，体重指数（BMI）（24.53±0.83 vs 25.37±1.04，P = 0.03）和去脂体重（41.04±0.83 vs 41.53±0.92，P = 0.05）显著增加。单因素分析显示，去脂体重的变化与全身骨矿物质密度（BMD）的变化显著相关（P = 0.03）。逐步多元线性回归分析显示，疾病活动与BMI（r2 = 0.41，P = 0.006）和脂肪量（r2 = 0.39，P = 0.007）的增加显著独立相关，运动和改良健康评估问卷与去脂体重的增加相关（r2 = 0.51，P = 0.007）。SLE诊断时的年龄和吸烟是全身BMD丢失的显著独立预测因素，而CS治疗时间是全身BMD增加的预测因素（r2 = 0.80，P < 0.0001）。
在这个SLE人群中，疾病活动是身体成分有害变化的预测因素，包括BMI和脂肪量的增加。患者相关变量也是身体成分变化的重要预测因素，运动独立预测去脂体重增加，吸烟预测全身BMD丢失。相比之下，未发现CS相关变量对身体成分有有害影响。去脂体重的变化而非脂肪量的变化可预测全身BMD的变化。
