【狼疮患者的骨折风险增加】

作者：Bultink IE 翻译：邓晓莉 校正：张警丰 刘湘源
发布者：闫冰 审校者：费雅楠

摘要
近年来狼疮患者的生存率有显著改善，因此其并发症得到更多关注。骨骼肌肉系统是狼疮第二常见的受累系统，受累后最常表现为骨质疏松及骨折。近期研究显示，狼疮患者骨量减少的发生率较高，且外周及椎体骨折的风险增加。狼疮患者有症状骨折的发生率较普通人群高1.2-4.7倍。一项纳入4343例狼疮患者及21780例年龄、性别匹配对照的大型人群研究显示，之前激素的应用及长病程是狼疮患者有症状骨折的重要危险因素。在这些相对年轻的患者中3，椎体骨折的患病率为18-50%，其中三分之一骨密度正常。狼疮患者骨量丢失原因多样，包括临床骨质疏松的传统危险因素、全身炎症、血清学因素、代谢因素、内分泌因素、药物副作用、可能还有遗传因素。一项对丹麦患者6年的随访研究显示，低维生素D水平、低体重指数及基线时用抗疟药与骨量丢失相关。另一项纵向研究显示，激素的应用与骨量丢失存在剂量依赖的相关性。这些研究具有临床实用价值，因为维生素D水平降低在狼疮患者中十分常见、抗疟药被认为是狼疮的“锚定药物”，而多数患者长期使用激素治疗。

附原文：
Abstract：Since survival of patients with systemic lupus erythematosus (SLE) has improved over the past decades, increasing attention is focused on complications of the disease. Osteoporosis and fractures contribute to damage in the second most frequently involved organ system in SLE: the musculoskeletal system. Recent studies have reported a high frequency of reduced bone mineral density in SLE, and an increased risk of peripheral and vertebral fractures. The incidence of symptomatic fractures is increased 1.2-4.7-fold in patients with SLE. A large population-based study on 4343 patients with SLE and 21 780 age-matched and sex-matched controls, demonstrated previous glucocorticoid use and longer disease duration as important risk factors for symptomatic fractures in SLE. Prevalent vertebral fractures are demonstrated in 18-50% of these relatively young patients, and one in three of these patients has normal bone density. The aetiology of bone loss in SLE is supposed to be multifactorial, involving clinicalosteoporosis risk factors, systemic inflammation, serological factors, metabolic factors, hormonal factors, medication-induced adverse effects and, possibly, genetic factors. A 6-year follow-up study on Dutch patients with SLE revealed that low 25-hydroxyvitamin D serum levels, low body mass index and baseline use of antimalarials were associated with bone loss. In addition, a dose-dependent relationship between glucocorticoid use and bone loss was demonstrated in longitudinal studies in SLE. These findings have implications for daily clinical practice, because vitamin D insufficiency is highly frequent in SLE, antimalarials are regarded as 'anchor drugs' for therapy and the majority of patients with SLE are on chronic glucocorticoid treatment.

引自：Bultink IE, Lems WF. Systemic lupus erythematosus and fractures. RMD Open. 2015 Aug 15;1(Suppl 1):e000069. doi: 10.1136/rmdopen-2015-000069. eCollection 2015.