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目的探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)患者并发骨缺血性坏死(avascular necrosis,AVN)的规律及相关高危因素。方法对新疆医科大学第一附属医院2005年1月—2013年1月住院的40例SLE并发AVN患者进行回顾性分析,同时以在该院明确诊断SLE而未并发AVN的58例患者作为对照,对两组患者相关临床表现进行比较,以了解SLE并发AVN的临床规律,并分析SLE患者发生AVN的危险因素。结果单因素分析显示,盘状红斑、浆膜炎、血小板减低、抗dsDNA抗体阳性、糖皮质激素最大剂量>50 mg(泼尼松)以及使用硫唑嘌呤两组比较P值<0.10。多因素Logistic分析显示,泼尼松最大治疗剂量>50 mg与患者并发AVN呈正相关,而使用硫唑嘌呤治疗与SLE患者并发AVN呈负相关。结论糖皮质激素治疗是患者并发AVN的危险因素,硫唑嘌呤治疗SLE有一定的研究价值。
Objective To investigate the regularity and related risk factors of avascular necrosis (AVN) in patients with systemic lupus erythematosus (SLE). Methods Forty patients with SLE complicated with AVN admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2005 to January 2013 were retrospectively analyzed. Meanwhile, 58 patients with confirmed SLE without AVN in the hospital were enrolled in this study. The clinical manifestations of the two groups of patients were compared to understand the clinical patterns of SLE complicated by AVN and to analyze the risk factors for AVN in patients with SLE. Results Univariate analysis showed that P value <0.10 for discoid erythema, serositis, thrombocytopenia, positive for anti-dsDNA antibody, maximum dose of glucocorticoid> 50 mg prednisone, and azathioprine. Multivariate Logistic analysis showed that the maximum dose of prednisone> 50 mg was positively correlated with AVN, while the use of azathioprine was negatively correlated with AVN in patients with SLE. Conclusion Glucocorticoid treatment is a risk factor for patients complicated with AVN. Azathioprine treatment of SLE has some research value.