Chanakul Ankanee, Khunrattanaphon Suriyaphon, Deekajorndech Tawatchai
Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Asian Biomed (Res Rev News). 2021 Oct 29;15(5):245-250. doi: 10.2478/abm-2021-0030. eCollection 2021 Oct.
Improvement of disease recognition and management has increased the survival of children with systemic lupus erythematosus (SLE), but has shifted the morbidity focus toward long-term complications, such as low bone mass and osteoporosis. Studies in adults with SLE show older age, chronic inflammation, and corticosteroid therapy are risk factors for low bone mineral density (BMD) and osteoporosis.
To determine the prevalence of and identify risk factors associated with low BMD in Thai children with SLE.
We conducted a retrospective review of demographic data and clinical variables for a cohort of 60 Thai children with SLE who underwent 2 dual-energy X-ray absorptiometry (DXA) at their initial examination and later follow-up. We considered a BMD score ≤ -2.0 to indicate low BMD. Binary logistic regression was used to assess risk factors potentially associated with low BMD.
The prevalence of low BMD at the first visit was 40% and increased to 55% over follow-up. We found a significantly decreased hip BMD score (median difference -0.25, 95% confidence interval [CI] -0.40 to -0.05; = 0.016) and lumbar BMD score (median difference -0.49, 95% CI -0.69 to -0.28; < 0.001) over time. The cumulative steroid dose tended to be higher for patients with low BMD (adjusted odds ratio [OR] = 1.08, 95% CI 1.00 to 1.17; = 0.050).
Low BMD has a 40% prevalence in Thai children newly diagnosed with SLE and progresses significantly over time. Higher cumulative corticosteroid dose tended to be associated with a low BMD, but we did not find a significant risk in this small sample.
疾病识别与管理的改善提高了系统性红斑狼疮（SLE）患儿的生存率，但发病重点已转向长期并发症，如低骨量和骨质疏松症。针对成年SLE患者的研究表明，年龄较大、慢性炎症和皮质类固醇治疗是低骨矿物质密度（BMD）和骨质疏松症的危险因素。
确定泰国SLE患儿低BMD的患病率，并识别与之相关的危险因素。
我们对60名泰国SLE患儿的队列进行了人口统计学数据和临床变量的回顾性分析，这些患儿在初次检查及后续随访时均接受了两次双能X线吸收测定法（DXA）。我们将BMD评分≤ -2.0视为低BMD。采用二元逻辑回归评估可能与低BMD相关的危险因素。
首次就诊时低BMD的患病率为40%，随访期间增至55%。我们发现，随着时间推移，髋部BMD评分显著降低（中位数差异为-0.25，95%置信区间[CI]为-0.40至-0.05；P = 0.016），腰椎BMD评分也显著降低（中位数差异为-0.49，95% CI为-0.69至-0.28；P < 0.001）。低BMD患者的累积类固醇剂量往往更高（调整后的优势比[OR] = 1.08，95% CI为1.00至1.17；P = 0.050）。
新诊断的泰国SLE患儿中，低BMD的患病率为40%，且随时间显著增加。累积皮质类固醇剂量较高往往与低BMD相关，但在这个小样本中我们未发现显著风险。
