Systemic Autoimmune Diseases Research Unit, Hospital de Especialidades, UMAE CMNMAC-CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Puebla, México.
Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Puebla, México.
PLoS One. 2018 Jun 13;13(6):e0196113. doi: 10.1371/journal.pone.0196113. eCollection 2018.
Observational studies have indicated a high but heterogeneous prevalence of low bone mineral density (BMD) and vertebral fractures (VF) in patients with systemic lupus erythematosus (SLE). Therefore, the objectives of this systematic review and meta-regression were: 1) to compare BMD between SLE patients and healthy controls and 2) to evaluate the relationship between BMD and glucocorticoid therapy and VF in SLE patients.
Articles were identified from electronic databases (PubMed, Embase, VHL, SciELO and the Cochrane Library). Prospective longitudinal and cross-sectional studies were considered for review. We evaluated the quality of the evidence included using the Oxford Centre for evidence-based medicine (EBM) Levels of Evidence. In total, 38 articles were identified and analyzed (3442 SLE cases and 6198 controls) in the analysis of BMD (9232 women and 408 men). There were significant differences in mean BMD between SLE patients and controls. BMD mean difference in cases/controls: -0.0566 95% CI (-0.071, -0.0439; p = < 0.0001). When only SLE patients were analyzed, the BMD did not significantly differ between patients who had or had not received glucocorticoid (GCT) therapy. 694 SLE patients were included in the analysis of VF (189 with VF vs. 505 without VF). Patients with VF had lower BMD than patients without VF (BMD mean difference without VF/with VF: 0.033 (95%CI: 0.006-0.060); p-value: 0.0156).
Patients with SLE had lower BMD than healthy controls. Moreover, SLE patients with VF had lower BMD than patients without VF. However, our data did not show that GCT therapy had an impact on BMD.
观察性研究表明，红斑狼疮（SLE）患者的骨矿物质密度（BMD）和椎体骨折（VF）的发生率较高，但存在异质性。因此，本系统评价和荟萃回归的目的是：1）比较 SLE 患者与健康对照组的 BMD，2）评估 SLE 患者的 BMD 与糖皮质激素治疗和 VF 之间的关系。
从电子数据库（PubMed、Embase、VHL、SciELO 和 Cochrane 图书馆）中检索文章。纳入了前瞻性纵向和横断面研究进行综述。我们使用牛津循证医学中心（EBM）证据水平评估纳入研究的证据质量。共确定并分析了 38 篇文章（3442 例 SLE 病例和 6198 例对照），用于 BMD 分析（9232 名女性和 408 名男性）。SLE 患者与对照组之间的平均 BMD 存在显著差异。病例/对照组的 BMD 平均差异：-0.0566（95%CI：-0.071，-0.0439；p<0.0001）。仅分析 SLE 患者时，接受或未接受糖皮质激素（GCT）治疗的患者之间的 BMD 无显著差异。694 例 SLE 患者纳入 VF 分析（189 例有 VF 与 505 例无 VF）。有 VF 的患者的 BMD 低于无 VF 的患者（无 VF/有 VF 的 BMD 平均差异：0.033（95%CI：0.006-0.060）；p 值：0.0156）。
SLE 患者的 BMD 低于健康对照组。此外，有 VF 的 SLE 患者的 BMD 低于无 VF 的患者。然而，我们的数据并未显示 GCT 治疗对 BMD 有影响。
