CAJ | 학술논문

骨关节植入物%骨与关节循证医学%系统性红斑狼疮%骨坏死%危险因素%激素%血管炎%高脂血症%雷诺现象%病例对照研究%Meta分析骨關節植入物%骨與關節循證醫學%繫統性紅斑狼瘡%骨壞死%危險因素%激素%血管炎%高脂血癥%雷諾現象%病例對照研究%Meta分析
골관절식입물%골여관절순증의학%계통성홍반랑창%골배사%위험인소%격소%혈관염%고지혈증%뢰낙현상%병례대조연구%Meta분석
bone and joint implants%evidence-based medicine of bone and joint%systemic lupus erythematosus%osteonecrosis%risk factor%glucocorticoids%vasc-ulitis%hyperlipidemia%Raynaud’s phenomenon%case-control study%Meta-analysis

背景：系统性红斑狼疮是一种异质性疾病，除长期应用激素可引起骨坏死外，有研究指出临床表现的差异性也有可能是骨坏死的危险因素。目前国内外学者对在系统性红斑狼疮患者中发生骨坏死的致病因素存在不同观点。 　　目的：对国内系统性红斑狼疮患者并发骨坏死的危险因素进行系统分析。 　　方法：检索中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBMdisc)、万方数据库获得已公开发表的国内系统性红斑狼疮并发骨坏死相关危险因素的病例对照研究文献，筛选出符合评价标准的文献，采用RevMan 5.0及Stata软件进行Meta分析，并计算各危险因素的合并比值比及95%置信区间。 　　结果与结论：共纳入10篇病例对照研究，累计病例组332例、对照组986例。系统性红斑狼疮并发骨坏死的各危险因素的比值比及95%置信区间分别为：雷诺现象3.28(1.69-6.38)，口腔溃疡2.95(2.13-4.09)，肾脏受累1.21(0.83-1.74)，血管炎因素5.64(2.84-11.21)，高脂血症5.11(3.10-8.42)，抗磷脂抗体2.32(1.49-3.61)，关节受累2.02(1.33-3.07)。提示激素应用明确为系统性红斑狼疮并发骨坏死的独立危险因素，但并非惟一因素，血管炎、高脂血症、雷诺现象、口腔溃疡、抗磷脂抗体阳性及关节受累均为需要重视的国内系统性红斑狼疮患者并发骨坏死的危险因素。
　　배경：계통성홍반랑창시일충이질성질병，제장기응용격소가인기골배사외，유연구지출림상표현적차이성야유가능시골배사적위험인소。목전국내외학자대재계통성홍반랑창환자중발생골배사적치병인소존재불동관점。 　　목적：대국내계통성홍반랑창환자병발골배사적위험인소진행계통분석。 　　방법：검색중국학술기간전문수거고(CNKI)、중국생물의학문헌수거고(CBMdisc)、만방수거고획득이공개발표적국내계통성홍반랑창병발골배사상관위험인소적병례대조연구문헌，사선출부합평개표준적문헌，채용RevMan 5.0급Stata연건진행Meta분석，병계산각위험인소적합병비치비급95%치신구간。 　　결과여결론：공납입10편병례대조연구，루계병례조332례、대조조986례。계통성홍반랑창병발골배사적각위험인소적비치비급95%치신구간분별위：뢰낙현상3.28(1.69-6.38)，구강궤양2.95(2.13-4.09)，신장수루1.21(0.83-1.74)，혈관염인소5.64(2.84-11.21)，고지혈증5.11(3.10-8.42)，항린지항체2.32(1.49-3.61)，관절수루2.02(1.33-3.07)。제시격소응용명학위계통성홍반랑창병발골배사적독립위험인소，단병비유일인소，혈관염、고지혈증、뢰낙현상、구강궤양、항린지항체양성급관절수루균위수요중시적국내계통성홍반랑창환자병발골배사적위험인소。
BACKGROUND:Systemic lupus erythematosus is a kind of heterogeneous disease, and the difference of clinical features may also be the risk factors of osteonecrosis besides of treatment with glucocorticoids according to the literature. However, it remains controversial on the risk factors of osteonecrosis in systemic lupus erythematosus patients. OBJECTIVE:To systematical y review the major risk factors of osteonecrosis in the Chinese patients with systemic lupus erythematosus. METHODS:The CNKI database, CBMdisc database and Wanfang database were retrieved for the published case-control study literatures on the risk factors of osteonecrosis in the Chinese patients with systemic lupus erythematosus. The literatures met the inclusion and exclusion criteria were included, and a Meta-analysis was conducted by RevMan 5.0 and Stata software. Then, the pooled odd ratio and 95%confidence interval of each risk factor were calculated. RESULTS AND CONCLUSION:Ten case-control study literatures were included involving 332 cases in the case group and 986 cases in the control group. The pooled odd ratio and 95%confidence interval of each risk factor of osteonecrosis in the Chinese patients with systemic lupus erythematosus were as fol ows:Raynaud’s phenomenon 3.28(1.69-6.38), dental ulcer 2.95(2.13-4.09), renal involvement 1.21(0.83-1.74), vasculitis 5.64(2.84-11.21), hyperlipidemia 5.11(3.10-8.42), anti-phospholipid antibody 2.32(1.49-3.61) and joints involvement 2.02(1.33-3.07). It has been clear that the glucocorticoids is an independent risk factor of osteonecrosis in the patients with systemic lupus erythematosus. However, it is not the one and only risk factor. The fol owing risk factors of vasculitis, hyperlipidemia, Raynaud’s phenomenon, dental ulcer, positive anti-phospholipid antibody and joints involvement are the risk factors of osteonecrosis in the patients with systemic lupus erythematosus.