Compeyrot-Lacassagne Sandrine, Tyrrell Pascal N, Atenafu Eshetu, Doria Andrea S, Stephens Derek, Gilday David, Silverman Earl D
Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Arthritis Rheum. 2007 Jun;56(6):1966-73. doi: 10.1002/art.22691.
Studies of adults with systemic lupus erythematosus (SLE) have frequently demonstrated the presence of decreased bone mineral density (BMD). However, there have been few investigations in pediatric patients to date. This study was undertaken to determine the prevalence of low BMD in patients with juvenile SLE and to identify associated risk factors.
We studied 64 consecutive patients with juvenile SLE in whom routine dual x-ray absorptiometry (DXA) scanning was performed. Lumbar spine osteopenia was defined as a BMD Z score of < -1 and > or = -2.5, and osteoporosis as a BMD Z score of < -2.5. Decreased hip BMD was defined as a value of < 80%. Data on disease activity, quality of life, disease-related damage, sex, ethnicity, body mass index, age at diagnosis, age at DXA, medication use and duration, clinical features, and puberty status were collected at the time of DXA.
Lumbar spine osteopenia was seen in 24 patients (37.5%) and osteoporosis in 13 (20.3%). Decreased hip BMD was present in 12 patients (18.8%). By univariate analysis, osteopenia was significantly correlated with age, disease duration, duration of corticosteroid use, cumulative corticosteroid dose, azathioprine use, cyclophosphamide use, lupus nephritis, and damage. Two additional variables, mycophenolate mofetil use and class III-IV nephritis, were associated with osteoporosis. Abnormal hip BMD was associated with disease duration, duration of corticosteroid use, and cumulative corticosteroid dose. By multivariate analysis, only disease duration remained in the model for osteoporosis and abnormal hip BMD, while cumulative corticosteroid dose was the variable associated with osteopenia.
These results indicate that osteopenia and osteoporosis are common in juvenile SLE and are associated more closely with increased disease duration than with cumulative corticosteroid dose.
针对成年系统性红斑狼疮（SLE）患者的研究经常表明存在骨矿物质密度（BMD）降低的情况。然而，迄今为止，针对儿科患者的此类研究较少。本研究旨在确定青少年SLE患者中低BMD的患病率，并识别相关危险因素。
我们对64例连续的青少年SLE患者进行了研究，这些患者均接受了常规双能X线吸收测定法（DXA）扫描。腰椎骨量减少定义为BMD Z评分＜-1且≥-2.5，骨质疏松症定义为BMD Z评分＜-2.5。髋部BMD降低定义为数值＜80%。在进行DXA时收集了疾病活动度、生活质量、疾病相关损伤、性别、种族、体重指数、诊断年龄、DXA检查年龄、药物使用及疗程、临床特征和青春期状态等数据。
24例患者（37.5%）出现腰椎骨量减少，13例（20.3%）出现骨质疏松症。12例患者（18.8%）存在髋部BMD降低。单因素分析显示，骨量减少与年龄、病程、皮质类固醇使用时间、皮质类固醇累积剂量、硫唑嘌呤使用、环磷酰胺使用、狼疮性肾炎及损伤显著相关。另外两个变量，即霉酚酸酯使用和Ⅲ-Ⅳ级肾炎，与骨质疏松症相关。髋部BMD异常与病程、皮质类固醇使用时间及皮质类固醇累积剂量相关。多因素分析显示，在骨质疏松症和髋部BMD异常的模型中，仅病程仍然存在，而皮质类固醇累积剂量是与骨量减少相关的变量。
这些结果表明，骨量减少和骨质疏松症在青少年SLE中很常见，且与病程延长的关系比与皮质类固醇累积剂量的关系更为密切。
