摘要
目的探讨SLE并发膝骨坏死的临床特点及影响因素，提高对该病的认识。方法对SLE合并膝骨坏死的患者进行回顾性分析，并按1：3比例抽取同期年龄、性别匹配的SLE患者作对照，收集整理其临床资料及有关实验室检查。采用t检验或矿检验进行统计分析。结果16例SLE合并膝骨坏死仅占同期Si．E住院患者的0．37％（16／4301）。其中男性1例。其余均为女性。年龄17-67岁，平均（36±13）岁。发生骨坏死年龄17～67岁，平均（36±13）岁。确诊骨坏死时SLE病程16～120个月，平均（64±40）个月。骨坏死m现症状至确诊时间2周至24个门，平均（5±6）个月。16例均累及股骨远端，8例同时胫骨近端坏死。MRI检出率100％，X线检出率19％。SLE合并膝骨坏死的患者皮肤血管炎、肌痛肌无力、骨质疏松、低蛋白血症、高脂血症、免疫球蛋白IgG升高发生率高于对照组（P〈0．05）。SLE合并膝骨坏死组入院前使用羟氯喹比例明显低于对照组（P〈0．05）。结论SLE并发膝骨坏死发生与多种因素有关，皮肤血管炎、肌痛肌无力、骨质疏松、低蛋白血症、高脂血症、免疫球蛋白IgG升高是SLE膝骨坏死的危险因素；使用羟氯喹可能减少膝骨坏死的发生；MRI检查可早期诊断膝骨坏死。
Objective To analyze the clinical features and factors associated with knee osteonecrosis in patients with systemic lupus erythematosus （SLE）. Methods Medical charts of Peking Union Medical College Hospital from 2000 to 2013 were reviewed to identify patients who were diagnosed as SLE with knee osteonecrosis. Controls were selected and matched to the cases by age and sex. The clinical and laboratory variables were compared between SLE patients who were with and without knee osteonecrosis. Numerical data and categorical data comparisons were analyzed using t-test, χ2-test, respectively. Results Sixteen patients developed knee osteonecrosis that constituted 0.37% of all the 4 301 hospitalized SLE patients during the same period. Fifteen patients were female, who developed knee osteonecrosis with an average age of 36 years （range： 17-67 years）. The mean duration of SLE before the diagnosis of knee osteonecrosis was 64±40 months （range： 16-120 months）. The interval from onset of symptoms to diagnosis was 0.5 to 24 months. The distal end of femur was involved in all 16 patients, while the proximal tibia necrosis also occurred in 8 patients. The detection rate of knee ostconecrosis by MR! was 100%, while it was only 19% by plain radiography. The incidence of skin vasculitis, myositis, osteoporosis, hyperlipidemia, hypoalbuminemia and elevated serum immunoglobin G levels were significantly higher in SLE patients with knee osteonecrosis than in controls （P〈0.05）. In addition, the use of anti-malarials was significantly lower in SLE patients with knee osteonecrosis than in controls （P〈0.05）. Conclusion The knee osteonecrosis in SLE patients is affected by multifactors. The risk factors include skin vasculitis, myositis osteoporosis, hyperlipidemia, hypoalbuminemia and the elevated immunoglobin G level. The use of antimalarial drugs in SEE patients may protect against knee osteonecrosis development. Knee osteonecrosis eonht be diagnosed early by MRI.
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2014年第3期176-181,共6页
Chinese Journal of Rheumatology
关键词
红斑狼疮
系统性
骨坏死
膝
Lupus erythematosus, systemic
Osteonecrosis
Knee
