Trapani S, Civinini R, Ermini M, Paci E, Falcini F
Department of Paediatrics, A Meyer Hospital, Florence, Italy.
Rheumatol Int. 1998;18(2):45-9. doi: 10.1007/s002960050056.
Peak bone mass is an important determinant of future bone mass and of the risk of osteoporosis and subsequent fractures. Although some information concerning bone mineral density (BMD) in adults affected with systemic lupus erythematosus (SLE) is available, few data on children and adolescents have been reported. Many variables, such as duration and activity of the disease, reduced sun exposure, and steroid therapy have been suggested as risk factors in the pathogenesis of osteoporosis in SLE. In this study, we longitudinally evaluated, by dual energy X-ray absorptiometry (DEXA), the BMD of 20 young patients affected with juvenile SLE (JSLE), in order to establish the degree of osteoporosis and the influence of steroid treatment, among other clinical variables. At baseline, the mean BMD in JSLE patients was 0.978 g/cm2 and in controls 1.038 g/cm2 (P = 0.31). At 1 year (time 2), this value became 0.947 g/cm2 in JSLE children; the mean individual difference was 0.28 g/cm2 (3.4%). Only in those patients aged 19-25 years BMD was significantly lower than in controls, both at baseline and at time 2. Considering the steroid treatment, no significant difference between the two groups was found either at baseline or at time 2; however, the mean yearly BMD loss in the steroid patients was 0.031 g/cm2 (3.5%) vs. 0.005 g/cm2 (0.5%) in those who had not taken steroids. A significantly inverse correlation between BMD and the cumulative dosage of corticosteroids has been detected. BMD produced a significantly inverse correlation to the cumulative dosage of corticosteroids; no significant correlation has been found between BMD and disease activity or duration.
峰值骨量是未来骨量以及骨质疏松症和随后骨折风险的重要决定因素。虽然已有一些关于成年系统性红斑狼疮（SLE）患者骨矿物质密度（BMD）的信息，但关于儿童和青少年的数据报道较少。许多变量，如疾病的持续时间和活动度、日照减少以及类固醇治疗，已被认为是SLE患者骨质疏松症发病机制中的危险因素。在本研究中，我们通过双能X线吸收法（DEXA）对20例青少年SLE（JSLE）年轻患者的骨密度进行了纵向评估，以确定骨质疏松程度以及类固醇治疗等其他临床变量的影响。基线时，JSLE患者的平均骨密度为0.978 g/cm²，对照组为1.038 g/cm²（P = 0.31）。1年后（时间2），JSLE儿童的这一数值变为0.947 g/cm²；个体平均差异为0.28 g/cm²（3.4%）。仅在19 - 25岁的患者中，基线和时间2时的骨密度均显著低于对照组。考虑类固醇治疗，两组在基线或时间2时均未发现显著差异；然而，接受类固醇治疗患者的平均每年骨密度损失为0.031 g/cm²（3.5%），而未服用类固醇患者为0.005 g/cm²（0.5%）。已检测到骨密度与皮质类固醇累积剂量之间存在显著负相关。骨密度与皮质类固醇累积剂量呈显著负相关；未发现骨密度与疾病活动度或持续时间之间存在显著相关性。
