骨坏的凶手，竟然是这个！！

内容：78例新确诊的系统性红斑狼疮患者的初始治疗需要高剂量的泼尼松龙治疗，包括甲基强的松龙冲击疗法。所有患者在给予激素治疗3个月后开始接受核磁共振成像检查，以检测股骨头早期的变化。这项检查在3个月后再进行一次。在开始激素治疗及治疗1个月后分别进行了实验室检查评估。

糖皮质激素治疗开始后3个月，MRI诊断股骨头坏死21例（26.9%），单侧11例，双侧10例。股骨头坏死的发生与SLE疾病活动指数、血清活性或肾功能无关，它也与身体质量指数（BMI）、体表面积（BSA）和每单位体重的初始泼尼松龙剂量无关。

然而，在无症状股骨头坏死患者中总胆固醇水平在开始激素治疗4周后往往是升高的。在症状股骨头坏死患者中高甘油三酯更明显，治疗前（P = 0.002）和激素治疗4周后（P = 0.036）。

结论：高甘油三酯是SLE患者无症状股骨头坏死的一个重要危险因素，而这种早期事件在这种患者人群中需要大规模流行病学调查。

附原文：Abstract The purpose of this study was to clarify the factors related to silent osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE). Seventyeight patients with SLE were selected on the basis of having been newly diagnosed and requiring high-dose prednisolone,including pulse therapy with methylprednisolone, as the initial treatment. All the patients initially underwent MRI at 3 months after the start of corticosteroid treatment to detect any early changes in the femoral head. These examinations were then performed again 3 months later. Laboratory parameters were evaluated at the start of steroid treatment and at 1 month thereafter.By 3 months after the start of corticosteroid treatment,silent ONFH was diagnosed by MRI in 21 patients (26.9 %),being bilateral in 11 patients and unilateral in 10. The occurrence of silent ONFH was not related to SLE disease activity index, serological activity, or renal function; it was also unrelated to body mass index (BMI), body surface area (BSA), and the initial dose of prednisolone per unit body weight.However, the total cholesterol level at 4 weeks after the start of steroid treatment tended to be higher in patients with silent ONFH. Patients with a higher triglyceride level showed a significantly higher frequency of silent ONFH both before (p=0.002) and 4 weeks after (p=0.036) steroid initiation.A high triglyceride level is an important risk factor for silent ONFH in patients with SLE, and large-scale epidemiologic surveys of such early events are needed in this patient population.

引自：Takeshi Kuroda, et al. High triglyceride is a risk factor for silent osteonecrosis of the femoral head in systemic lupus erythematosus. Clin Rheumatol (2015) 34:2071-2077.