Objective: To investigate the effect of long-term low dose prednisone administration on bone mineral density (BMD) in patients with inactive systemic lupus erythematosus (SLE). Methods: A total of 118 inactive female SLE patients with long-term administration of low dose prednisone were recruited from the Department of Rheumatology and Immunology at An hui Provincial Hospital.All patients were given low dose prednisone for long-term (≤10 mg/d, more than half a year). According to prednisone doses, subjects were divided into two groups, namely group A (≤7.5 mg/d) and group B (7.5-10 mg/d). In addition, patients were also divided into four groups based on the duration of administration, including groupⅠ≤3 years, Ⅱfrom 4-5 years, Ⅲ 6-10 years and Ⅳ>10 years.Twenty-nine healthy people were recruitedas normal controls.The BMD was measured by dual energy X-ray absorptiometry.The association of BMD with prednisone dose and duration was compared between different groups. Results: The incidence of osteopenia in all patients with SLE was 42.4%(50/118), and the incidence of osteoporosis was 14.4%(17/118). BMD of all bone sites in both group A and B were significantly lower than that in normal control group (P<0.05). Similarly, the BMD of all bone sites in groupⅠ, Ⅱ, Ⅲ and Ⅳ were significantly decreased (P<0.05). What needed to be stressed was the BMD in group Ⅳ was lower than those in other three groups (P<0.05). Multiple logistic regression analysis showed that the cumulative prednisone dose was the risk factor for osteopenia, while taking calcium and alfacalcidol were protective factors. Conclusion: Long-term use of low dose prednisone result in the decrease of BMD in patients with inactive SLE.The lumbar spine and femoral neck had more severe osteopenia. Long-term administration of prednisone, even less than 7.5 mg/d, can also cause osteopenia.Calcium and alfacalcidol were protective factors of BMD.
目的：研究长期服用小剂量泼尼松对缓解期系统性红斑狼疮(SLE)患者骨密度的影响。方法：选长期服用小剂量泼尼松的女性缓解期SLE患者118例，同时选年龄、性别、BMI相匹配的健康对照者29例。采用双能X线吸收法测所有受试者骨密度，分析骨密度与病程及泼尼松剂量的相关性。结果： 118例女性缓解期SLE患者中骨量减少50例(42.4%)，骨质疏松17例(14.4%)。股骨颈、股骨、桡骨远端、桡骨、腰椎(L(2～4))的骨密度口服泼尼松≤7.5 mg/d SLE患者[(0.897±0.116) g/cm(2)，(0.931±0.115) g/cm(2)，(0.366±0.058) g/cm(2)，(0.523±0.054) g/cm(2)，(1.052±0.143) g/cm(2)]、泼尼松7.5～10 mg/d者[(0.871±0.138) g/cm(2,) (0.935±0.143) g/cm(2,) (0.358±0.055) g/cm(2,) (0.515±0.056) g/cm(2,) (1.056±0.140)g/cm(2)]均低于健康对照者[(1.020±0.107) g/cm(2,) (1.081±0.129) g/cm(2,) (0.393±0.524) g/cm(2,) (0.556±0.050) g/cm(2,) (1.239±0.114)g/cm(2)，P<0.05]。SLE病程≤3年者、SLE病程4～5年者、SLE病程6～10年者、SLE病程>10年者上述检测部位的骨密度均低于健康对照者(P<0.05)，SLE病程>10年者上述检测部位的骨密度均低于SLE病程≤3年者、SLE病程4～5年者、SLE病程6～10年者(P<0.05)。多因素logistic回归分析显示，累积泼尼松剂量与骨量减少相关(OR＝1.069，95% CI 1.008～1.133，P＝0.025)，补充钙剂(OR＝0.343，95% CI 0.135～0.868，P＝0.024)、阿法骨化醇(OR＝0.320，95% CI 0.112～0.913，P＝0.033)是骨密度的保护性因素。结论：缓解期SLE患者长期服用小剂量泼尼松导致不同程度的骨密度减低，以腰椎和股骨颈的发生率最高。长期应用泼尼松≤7.5 mg/d也导致骨密度明显减低。补充钙剂、阿法骨化醇是骨密度的保护性因素。.
Keywords: Bone density; Lupus erythematosus, systemic; Osteoporosis; Prednisone.