女性多发性肌炎及皮肌炎患者骨密度相关因素分析

摘要

Objective To observe the change of bone mineral density in female patients with Polymyositis and Dermatomyositis and to assess the influence of the clinical index, the dosage and duration of glucocorticoid on bone mineral density. Methods Bone mineral density was measured at the femur neck, Ward's trigone, trochanter and left distal radius in 36 female patients with Polymyositis and Dermatomyositis by dual energy X-ray absorptionmetry. The clinical manifestation, laboratory data, the dosage and duration of glucocorticoid were also recorded at the same time. Results The bone loss in female patients with Polymyositis and Dermatomyositis was more significant than that in healthy controls (P < 0.05 ). Abnormal bone mass occurred more in elderly Polymyositis and Dermatomyositis patients. The duration of glucocorticoid in Polymyositis and Dermatomyositis patients was longer than those in normal controls (P < 0. 05 ). The accumulated dose of glucocorticoid in Polymyositis and Dermatomyositis patients was higher than those in normal controls( P < 0.05 ). The incidence rate of osteoporosis in the amenerrheic patients was higher than that in patients who were not amenerrheic ( P < 0.05 ). There was linear regression relationship between the duration of glucocorticoid treatment, accumulated dose of glueocorticoid and bone mineral density in the femur neck by multiple linear regression analysis. Conclusion The incidence of osteoporosis in female patients with Polymyositis and Dermatomyositis is higher than that in controls. Osteoporosis occurs more frequently in amenorrheal women. The duration of glucocorticoid treatment, and accumulated doses of glucocorticoid are risk factors for bone mineral density decrease in female patients with Polymyositis and Dermatomyositis.%目的 探讨女性多发性肌炎及皮肌炎患者骨密度的变化和骨质疏松的发生情况,并讨论疾病的病情和激素用量对骨密度的影响.方法 采用双能X线骨密度仪分别测量36例女性多发性肌炎及皮肌炎患者(多发性肌炎及皮肌炎组)和健康女性(对照组)的股骨颈、三角区、大转子及左前臂桡骨远端的骨密度,并同时记录多发性肌炎及皮肌炎患者的症状变化、临床指标、激素使用情况.对多发性肌炎及皮肌炎患者诸多影响骨密度的因素进行统计学分析.结果 多发性肌炎及皮肌炎组中骨量减少及骨质疏松的发生率高于对照组(P<0.05).多发性肌炎及皮肌炎组中骨量异常的患者比骨量正常的患者年龄更大、病程更长、激素使用时间更长、激素累积用量更大(P<0.05).与非闭经妇女相比,闭经妇女出现骨质疏松的比例增加(P<0.05).多元线性回归分析发现激素的使用时间、激素的累积剂量与股骨颈骨密度值有线性回归关系.结论 多发性肌炎及皮肌炎患者骨质疏松的发生率较正常人群明显增高,闭经妇女更易出现骨质疏松,激素的使用时间及累积剂量是影响骨密度的重要因素.