Study on the relationship between hip bone loss rate and femoral head necrosis in patients with systemic lupus erythematosus one year after the disease
Objective To investigate the changes of bone mineral density loss in systemic lupus erythematosus(SLE)patients with secondary necrosis of femoral head(ONFH)at the first time being diagnosed,1 year later and the last visit.Methods One hundred and seven patients with SLE who were hospitalized in the Department of Rheumatology and Immunology of the First Affiliated Hospital of Xi'an Jiaotong University from January 2019 to December 2020 were retrospectively analyzed.Among them,23 patients in the experimental group developed femoral head necrosis and 84 patients without ONFH were served as the control group.Bone density data of lumbar spine and hip were collected at the time of initial diagnosis of SLE in the two groups.Propensity score matching(PSM)method was used to match the patients in the femur head necrosis group and the non-necrosis group 1∶2(n=20 vs.n=40).General demographic characteristics,BMI,SLEDAI,initial glucocorticoid dosage,and initial lumbar and hip bone mineral density were comparable between groups.Lumbar/hip bone mineral density(BMD)data of the two groups were collected after 1 year's return visit and at the last visit,and the reduction value and proportion of lumbar/hip BMD in the first year of initial diagnosis were compared.The BMD reduction and rate of lumbar spine/hip were compared during the whole observation period.logistic regression analysis was performed to verify the correlation between the above BMD parameters and ONFH in 107 SLE patients,and the sensitivity and specificity of the parameters to ONFH were determined by ROC curve.Results Hip BMD of SLE patients in the femur head necrosis group decreased by 6.83％in the first year after SLE diagnosis,which was higher than that in the non-necrosis group[(-6.828±6.212％)vs.(0.753±2.058)％,t=5.31,P＜0.001].Logistics regression analysis suggested that the decrease rate of hip BMD in the first year increased the risk of femoral head necrosis[OR(95％CI)=12.346(3.106,47.619),x2=12.76,P＜0.001],the one-year hip BMD decline rate had the largest AUC for predicting ONFH,with the best prediction threshold of 0.92％,the corresponding sensitivity and specificity was 92.9％,and 91.3％respectively.Conclusion The hip bone loss rate is positively correlated with the risk of femoral head necrosis in the first year after initial diagnosis of lupus erythematosus.The loss rate greater than 0.92％indicates an increased risk of femoral head necrosis.
Lupus erythematosus,systemicFemoral head necrosisBone densityPropensity matching score
NETL
NSTL
万方数据
