| Systemic lupus erythematosus(SLE)is a chronic inflammatory autoimmune disease,which is characterized by multiple clinical manifestations.Although the pathological mechanism of SLE hasn’t been fully understood,many studies suggested that SLE could do serious damage to human health,especially to the female patients.A large number of studies have suggested risk factors for osteoporosis,including the use of corticosteroids has been shown to be important in the development of low bone mineral density(BMD)and an increased fracture risk.The treatment of SLE drugs is mainly glucocorticoids,so SLE patients have become high-risk groups of osteopenia and osteoporosis.Therefore,it is particularly important for us to focus attention on the prevention and treatment of SLE patients with osteoporosis.Objective: To investigate different doses and application time of glucocorticoid cumulant on bone mineral density in premenopausal female patients with SLE,and to study the correlation between different doses of glucocorticoid cumulant and bone mineral density in premenopausal female patients with SLE.Methods:1 This study was conducted in Department of Rheumatology,The Second Hospital of Hebei Medical University from September to December,2016.A total of 70 individuals were involved in the study.The data of 54 premenopausal female patients with SLE were collected and all these patients were in conformity with the revision of SLE diagnostic criteria of the American Rheumatism Association in 1997.16 healthy premenopausal female were collected as the control group.The SLE group was divided into three subgroups by glucocorticoid cumulant,low cumulant group(lower than 10g),middle cumulant group(higher than 10 g and lower than 30g)and high cumulant group(higher than 30g).The SLE group was divided into three subgroups by glucocorticoid application time,short time group(shorter than 3 years),middle time group(longer than 3 years and shorter than 8 years)and long time group(longer than 8 years).2 The T value of bone mineral density in lumbar spine,left side of the femoral neck and left hip bone were detected by dual-energy X-ray absorptiometry(DEXA).3 The serum level of PINP andβ-CTx were measured by(Enzyme linked immunosorbent assay,ELISA).Compare the difference and analyze the association among these groups.4 All statistical analyses were performed using SPSS 21.0 software.A P-value <0.05 was regarded as statistically significant.Results:1 Comparison of the control group and SLE groupThere were 54 premenopausal female patients with SLE in the SLE group,and 43 of them had become osteopenia.The incidence of bone loss was 79.63% in SLE group.There were 16 premenopausal female in the control group,and 5 of them had become osteopenia.The incidence of bone loss was 31.25% in control group.There was no significant difference in age,weight,and BMI between the control group and SLE group(P>0.05).The incidence of bone loss in SLE group was higher than the control group.The T value of lumbar and femoral neck in SLE group were lower than the control group(P<0.05).Compared with the control group,the T value of the hip joint in SLE group were lower,but there were no significant difference between the two groups(P>0.05).The bone mineral density of lumbar and femoral neck and hip joint in SLE group were lower than the control group(P<0.05).The serum levels of PINP were higher than the control group,and the serum levels of β-CTx were lower in SLE group,but there were no significant difference between the two groups(P>0.05).2 Comparison of the control group and different doses of glucocorticoid cumulant groupThere were 12 premenopausal female patients with SLE in the low cumulant group,and 10 of them had become osteopenia.The incidence of bone loss was 83.33% in the low cumulant group.24 premenopausal female was divided into the middle cumulant group,and 18 of them had become osteopenia.The incidence of bone loss was 75% in the middle cumulant group.In the high cumulant group,15 of 18 SLE patients had become osteopenia,and the incidence of bone loss was 83.33%.There was no significant difference in age,weight,and BMI among the four group(P > 0.05).The incidence of bone loss in different doses of glucocorticoid cumulant group were higher than the control group(P<0.05).The T value of lumbar in the different doses of cumulant group were lower than the control group(P<0.05).The T value of femoral neck among the four group were differernt(P<0.05).There was no significant difference among the four group in the T value of the hip joint(P>0.05).There was no significant difference in the bone mineral density of lumbar in the different doses of cumulant group(P>0.05).The bone mineral density of femoral neck in the high and middle of cumulant group were lower than the short group(P<0.05).The bone mineral density of hip joint in the high group were lower than the short group(P<0.05).The results showed that there was no significant difference in the serum level of PINP and β-CTx among the four group(P>0.05).3 Associations between the different doses of glucocorticoid cumulant and related metabolic factorsThe correlation of different doses of glucocorticoid cumulant with related metabolic factors was detected by Spearman’s correlation coefficient.The results showed that different doses of glucocorticoid cumulant level were positively correlated with the application time(P<0.05).The different doses of glucocorticoid cumulant level were negatively correlated with the lumbar,femoral neck,the hip joint(P<0.05).4 Comparison of the control group and the different application time of glucocorticoidThere were 15 premenopausal female patients with SLE in the short course of glucocorticoid treatment group,and 9 of them had become osteopenia.The incidence of bone loss was 60% in the short course of glucocorticoid treatment group.26 premenopausal female was divided into the middle course of glucocorticoid treatment group,and 21 of them had become osteopenia.The incidence of bone loss was 80.77% in the middle course of glucocorticoid treatment group.In the long course of glucocorticoid treatment group,13 of 13 SLE patients had become osteopenia,and the incidence of bone loss was 100%.There was no significant difference in age,weight,and BMI among the four group(P>0.05).The incidence of bone loss in middle and long course of glucocorticoid treatment group were higher than the control group,while compared with the different course of glucocorticoid treatment,the incidence of bone loss in long course of glucocorticoid treatment group were higher than short course of glucocorticoid treatment group(P<0.05).The T value of lumbar in the long course of glucocorticoid treatment group were lower than the short and middle course of glucocorticoid treatment group(P<0.05).The T value of femoral neck in the long course of glucocorticoid treatment group were lower than the short and middle course of glucocorticoid treatment group(P<0.05).The T value of the hip joint in the long course of glucocorticoid treatment group were lower than the short and middle course of glucocorticoid treatment group(P<0.05).The bone mineral density of lumbar and femoral neck and hip joint in the long course of glucocorticoid treatment group were all lower than the short and middle course of glucocorticoid treatment group(P<0.05).The serum level of β-CTx in the long course of glucocorticoid treatment group were lower than the short course of glucocorticoid treatment group(P<0.05).There was no significant difference in the serum level PINP among the four group(P>0.05).5 Associations between the different application time of glucocorticoid and related metabolic factorsThe correlation of different application time of glucocorticoid cumulant with related metabolic factors was detected by Spearman’s correlation coefficient.The results showed that application time of glucocorticoid cumulant was positively correlated with different doses of glucocorticoid cumulant level(P<0.05).The different application time of glucocorticoid was negatively correlated with the lumbar,femoral neck,the hip joint,serum level of P(P<0.05).Conclusion:1 The patients with SLE could appear osteopenia and osteoporosis after glucocorticoid treatment.2 The longer the time of glucocorticoid has been applied,the more the bone mineral density of SLE patients prone to decrease.3 The different doses of glucocorticoid cumulant level were negatively correlated with the lumbar,femoral neck,the hip joint,which suggested the more the dose of glucocorticoid has been accumulated,the more the bone mineral density prone to decrease. |
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