摘要
目的了解中国服用糖皮质激素风湿病患者骨质疏松的发病情况和诊疗现状,以期引起对骨质疏松防治的重视。方法 2012年11月1日至2013年1月31日,在全国46家风湿病专科医院对3 136例曾经或正在服用糖皮质激素的风湿病患者进行临床资料、用药情况及骨量调查,了解骨量减少和骨质疏松的发生率。结果 (1)所有调查患者中,主要病种为类风湿关节炎(1 069例)和系统性红斑狼疮(983例)。3 136例患者中90%存在骨量减少或骨质疏松,其中骨质疏松的发生率为41.4%。44.7%的患者在调查当时糖皮质激素用量(等效于泼尼松)>7.5 mg/d,调查当时糖皮质激素剂量≤2.5 mg/d者仍有58.5%存在骨质疏松。(2)随着年龄增加,骨质疏松及骨折的发病率明显增加;小于30岁的患者骨量减少和骨质疏松总发生率为74.4%。(3)女性风湿病患者骨密度异常比例高于男性,平均停经年龄低于正常人群(45.8岁)。(4)抗骨质疏松药物使用不规范,32.7%的患者从未预防性给予抗骨质疏松药物治疗,在T<-2.5的患者中,35.6%未给予预防性抗骨质疏松治疗。主要用药为钙和维生素D,20.9%的患者仅给予钙剂单独治疗,仅有4%使用膦酸盐类药物。结论我国应用糖皮质激素的风湿病患者骨量减少和骨质疏松发生率明显增高,且预防性用药不规范。
Objective To investigate the incidence and treatment of bone loss in rheumatic patients treated glueocorticoid in China. Methods From November 1, 2012 to January 34, 2013, 3 136 cases of rheumatic disease who had been or were taking glucocorticoid from 46 rheumatology centers nationwide were included and their clinical data, medications, as well as bone mass were investigated. Results （ 1 ） RA （ 1 069 cases） and SLE （983 cases） patients accounted for the majority. Osteopenia or osteoporosis was observed in 90% of the 3 136 patients, and 41.4% patients were found to be osteoporotic. Nearly half of patients （44. 7% ） with a dosage of glucocorticosteroid （equivalent to prednisone ） 〉 7.5 mg/d. Even those with a daily dose of glucocorticosteroid （equivalent to prednisone） ≤2.5 mg, 58.5% were reported to be osteoporotic. （2） There were increased risk of osteoporosis and fracture with age. In patients younger than 30 years Of age, 74.4% were reported of bone mass reduction or osteoporosis. （3） The incidence of abnormal bone mineral density in women were higher than that in men. The mean age at menopause was lower than that the average （45.8 years） （4） Most patients were not given adequate treatment. Prophylactic anti-osteopontin therapy was never given in 32.7% of patients, nor did 35.6% of patients with T score 〈-2. 5 received prophylactic anti-osteoporosis treatment. The mostly used treatment were calcium and vitamin D, 20. 9% received calcium alone, only 4% received bisphosphonates. Conclusion The incidence of bone mass reduction or osteoporosis in Chinese rheumatic patients is high while most patients are not given adequate treatment.
出处
《中华临床免疫和变态反应杂志》
2017年第3期277-284,共8页
Chinese Journal of Allergy & Clinical Immunology
