College of Orthopedics and Traumatology, Henan University of Chinese Medicine, Zhengzhou, China.
Department of Orthopedics and Traumatology, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.
Front Immunol. 2024 Aug 21;15:1381035. doi: 10.3389/fimmu.2024.1381035. eCollection 2024.
Osteonecrosis of the femoral head (ONFH) is a severe complication of systemic lupus erythematosus (SLE) and occurs more frequently in SLE patients than in other autoimmune diseases, which can influence patients' life quality. The objective of this research was to analyze risk factors for the occurrence of ONFH in female SLE patients, construct and validate a risk nomogram model.
Clinical records of SLE patients who fulfilled the 1997 American College of Rheumatology SLE classification criteria were retrospectively analyzed. The Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analysis were used to summarize the independent risk factors of ONFH in female SLE patients, which were used to develop a nomogram. The predictive performance of the nomogram was assessed using the receiver characteristic (ROC) curve, calibration curves and decision curve analysis (DCA).
793 female SLE patients were ultimately included in this study, of which 87 patients (10.9%) developed ONFH. Ten independent risk factors including disease duration, respiratory involvement, menstrual abnormalities, Sjögren's syndrome, osteoporosis, anti-RNP, mycophenolate mofetil, cyclophosphamide, biologics, and the largest daily glucocorticoid (GC) were identified to construct the nomogram. The area under the ROC curve of the nomogram model was 0.826 (: 0.780-0.872) and its calibration for forecasting the occurrence of ONFH was good ( = 5.589, = 0.693). DCA showed that the use of nomogram prediction model had certain application in clinical practice when the threshold was 0.05 to 0.95. In subgroup analysis, we found that the risk of ONFH was significantly increased in age at SLE onset of ≤ 50 years old, largest daily GC dose of ≥50 mg and the therapy of GC combined with immunosuppressant patients with menstrual abnormalities.
Menstrual abnormalities were the first time reported for the risk factors of ONFH in female SLE patients, which remind that clinicians should pay more attention on female SLE patients with menstrual abnormalities and take early interventions to prevent or slow the progression of ONFH. Besides, the nomogram prediction model could provide an insightful and applicable tool for physicians to predict the risk of ONFH.
股骨头坏死（ONFH）是系统性红斑狼疮（SLE）的一种严重并发症，在 SLE 患者中比在其他自身免疫性疾病中更为常见，这会影响患者的生活质量。本研究旨在分析女性 SLE 患者发生 ONFH 的危险因素，构建并验证风险列线图模型。
回顾性分析符合 1997 年美国风湿病学会 SLE 分类标准的 SLE 患者的临床记录。采用最小绝对收缩和选择算子（LASSO）回归和多因素 logistic 回归分析总结女性 SLE 患者发生 ONFH 的独立危险因素，用于建立列线图。通过受试者工作特征（ROC）曲线、校准曲线和决策曲线分析（DCA）评估列线图的预测性能。
本研究最终纳入 793 例女性 SLE 患者，其中 87 例（10.9%）发生 ONFH。10 个独立危险因素，包括疾病持续时间、呼吸受累、月经异常、干燥综合征、骨质疏松症、抗核仁抗体、霉酚酸酯、环磷酰胺、生物制剂和最大日糖皮质激素（GC），被确定用于构建列线图。列线图模型的 ROC 曲线下面积为 0.826（0.780-0.872），其预测 ONFH 发生的校准效果良好（=5.589，=0.693）。DCA 表明，当阈值在 0.05 到 0.95 之间时，列线图预测模型在临床实践中有一定的应用价值。在亚组分析中，我们发现 SLE 发病年龄≤50 岁、最大日 GC 剂量≥50mg 和 GC 联合免疫抑制剂治疗且伴有月经异常的患者，ONFH 的风险显著增加。
月经异常为女性 SLE 患者发生 ONFH 的危险因素，首次报道，提醒临床医生应更加关注伴有月经异常的女性 SLE 患者，并采取早期干预措施，预防或减缓 ONFH 的进展。此外，该列线图预测模型可为医生预测 ONFH 风险提供一种有见地且适用的工具。
