CAJ | 학술논문

目的：观察狼疮性肾炎（ LN）患者使用糖皮质激素（ GC）治疗后的骨密度变化情况，探讨LN患者骨质疏松症的预防措施。方法以初次诊断为LN并使用GC治疗半年以上的患者为研究对象，与使用GC治疗前相对照。使用GC治疗过程中按照美国风湿病协会（ ACR）指南建议给予骨质疏松症的预防治疗，每6月监测骨密度。结果入组患者共82例，其中女性74例，男性8例，年龄14～72岁，平均（35.8±14.5）岁，使用GC （7.5-63.4）月，平均（30.3±18.0）月，累积使用GC剂量（8.5-32.5）g，平均（18.6±6.8）g。 GC治疗过程中骨量减少及骨质疏松的发生率分别为20.73％和10.98％，均显著高于治疗前（P＜0.05）；GC治疗过程中腰椎及股骨颈骨密度均显著低于治疗前（ P＜0.05），随着使用GC时间的延长以及累积剂量的增加，骨密度呈递减趋势；GC的累积剂量是骨质疏松的危险因素。结论 LN患者应长期定期进行骨密度检测以评估骨骼健康状况，同时对预防和治疗等干预进行评估，以预防骨质疏松的发生。
목적：관찰랑창성신염（ LN）환자사용당피질격소（ GC）치료후적골밀도변화정황，탐토LN환자골질소송증적예방조시。방법이초차진단위LN병사용GC치료반년이상적환자위연구대상，여사용GC치료전상대조。사용GC치료과정중안조미국풍습병협회（ ACR）지남건의급여골질소송증적예방치료，매6월감측골밀도。결과입조환자공82례，기중녀성74례，남성8례，년령14～72세，평균（35.8±14.5）세，사용GC （7.5-63.4）월，평균（30.3±18.0）월，루적사용GC제량（8.5-32.5）g，평균（18.6±6.8）g。 GC치료과정중골량감소급골질소송적발생솔분별위20.73％화10.98％，균현저고우치료전（P＜0.05）；GC치료과정중요추급고골경골밀도균현저저우치료전（ P＜0.05），수착사용GC시간적연장이급루적제량적증가，골밀도정체감추세；GC적루적제량시골질소송적위험인소。결론 LN환자응장기정기진행골밀도검측이평고골격건강상황，동시대예방화치료등간예진행평고，이예방골질소송적발생。
Objective To investigate the changes of bone mineral density ( BMD ) in patients with lupus nephritis during glucocorticoids ( GC) therapy, and to explore the prevention methods of osteoporosis ( OP) in such patients.Methods Patients who were diagnosed as lupus nephritis for the first time and had been treated with GC for at least 6 months were selected.Their clinical data were observed and compared with that before GC treatment.During the GC treatment, all patients were also given preventive treatments of osteoporosis according to American College of Rheumatology 2001 Recommendation.BMD of the lumbar vertebrae and the femoral neck was detected every 6 months.Results A total of 82 patients, including 74 females and 8 males, aging from 14 to 72 years old, with an average age of 35.8 ±14.5 years old, were included in this study.The duration of GC treatment ranged from 7.5 to 63.4 months, with an average of 30.3 ±18.0 months, and the accumulative dose of GC ranged from 8.5 to 32.5 g, with an average of 18.6 ±6.8 g.Among them, osteopenia and osteoporosis were found in 20.73% and 10.98%patients, respectively, which were both higher than those before GC treatment (P<0.05).BMD of the lumbar vertebrae and the femoral neck decreased along with the increase of duration and accumulative dose of GC ( P<0.05 ) .Accumulation of GC was a risk factor of osteoporosis.Conclusion Long-term and regular detection of BMD in patients with LN should be performed in order to evaluate bone health status, and the evaluation of the preventative and therapeutic strategies should be performed simultaneously to prevent osteoporosis.