糖皮质激素性骨质疏松症骨代谢与糖皮质激素用药时间的相关性

doi:10.6040/j.issn.1671-7554.0.2016.1681

摘要/Abstract

摘要： 目的观察骨代谢在糖皮质激素性骨质疏松症(GIOP)进展过程中与糖皮质激素用药时间的关系及变化规律,并依据骨代谢变化趋势探讨GIOP的防治策略。方法检测应用GC控制病情的系统红斑狼疮患者117例和健康人群21例骨代谢标志物(β-CTX、T-P1NT、N-MIDOs),测定L1-4椎体骨密度。依据GC使用时间将患者分为7个亚组:Ⅰ组用药1~6个月,Ⅱ组用药7~12个月,Ⅲ组用药13~18个月,Ⅳ组用药19~24个月,Ⅴ组用药25~30个月,Ⅵ组用药31~36个月,Ⅶ组用药>36个月。结果 Ⅰ组、Ⅱ组和Ⅲ组β-CTX较正常对照组明显升高,差异有统计学意义(P<0.05);Ⅵ组和Ⅶ组β-CTX较正常对照组明显减低,差异有统计学意义(P<0.05);Ⅳ组和Ⅴ组β-CTX较正常对照组无明显差异(P>0.05);应用GC的各亚组T-P1NT、N-MIDOs均较正常对照组明显减低,差异有统计学意义(P<0.05);Ⅱ~Ⅶ组骨密度较正常对照组明显减低,差异有统计学意义(P<0.05)。结论 GIOP形成过程中,骨代谢是由高分解状态向低分解低成骨低转换状态转变。应用GC 1~18个月的SLE患者骨代谢状态处于高分解低成骨,应用GC 30个月以上的患者骨代谢状态处于低分解低成骨低转换状态。

关键词: 糖皮质激素性骨质疏松症, 系统性红斑狼疮, 糖皮质激素, 骨代谢标志物, 骨密度

Abstract: Objective To investigate the changes of bone metabolism in different durations of glucocorticoid(GC)treatment of systemtic lupus erythematosus(SLE), and to explore the therapeutic schedule of glucocorticoid-induced osteoporosis(GIOP). Methods A total of 117 pre-menopausal women with SLE were involved as the observation group and 21 healthy pre-menopausal women served as the control group. According to the duration of GC therapy, the patients were divided into 7 subgroups: group Ⅰ(medication for 1~6 months), group Ⅱ(medication for 7~12 months), group Ⅲ(medication for 13~18 months), group Ⅳ(medication for 19~24 months), group Ⅴ(medication for 25~30 months), group Ⅵ(medication for 31~36 months), and group Ⅶ(medication for >36 months). The contents of amino-terminal-propeptide of type I collagen(T-PINT), amino-terminal of osteocalcin(N-MIDOs), type I collagen cross-linked C-telopeptide degradation fragments(β-CTX)and bone mineral density(BMD)of all subjects were measured. Results The serum β-CTX level was significantly elevated in group Ⅰ, Ⅱ and Ⅲ, and remark- 山东大学学报 (医学版)55卷5期 -徐大霞,等.糖皮质激素性骨质疏松症骨代谢与糖皮质激素用药时间的相关性 \=-ably reduced in group Ⅵ and Ⅶ compared with the control group(P<0.05), while there was no difference in group Ⅳ and V(P>0.05). The serum levels of T-PINT and N-MIDOs in all subgroups were significantly lower than those in the control group(P<0.05). The BMD of patients receiving more than 6-month GC therapy was significantly lower than that of healthy controls(P<0.05). Conclusion In conclusion, the change of bone metabolism is from high decomposition to low decomposition and low osteogenesis in the process of GIOP formation. In the first 18 months of GC therapy, bone metabolism is in the state of low osteogenesis and high decomposition; after 30 months, it is in the state of low osteogenesis and low decomposition.

Key words: Glucocorticoid-induced osteoporosis, Systemic lupus erythematosus Glucocorticoid, Bone metabolism, Bone mineral density

中图分类号:

R593.24

徐大霞,侯楠,李晓峰,王闯,孔猛,焦广俊,陈允震. 糖皮质激素性骨质疏松症骨代谢与糖皮质激素用药时间的相关性[J]. 山东大学学报（医学版）, 2017, 55(5): 103-107.

XU Daxia, HOU Nan, LI Xiaofeng, WANG Chuang, KONG Meng, JIAO Guangjun, CHEN Yunzhen. Relevance between bone metabolism of glucocorticoid-induced osteoporosis and duration of glucocorticoid treatment[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(5): 103-107.

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