<sup>99</sup>锝-亚甲基二膦酸盐治疗系统性红斑狼疮合并股骨头坏死的临床研究

段聪聪; 沈梦佳; 侯传云; 江超; 谢长好; 王涛

doi:10.16766/j.cnki.issn.1674-4152.003101

⁹⁹锝-亚甲基二膦酸盐治疗系统性红斑狼疮合并股骨头坏死的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.003101

段聪聪¹,
沈梦佳¹,
侯传云¹,
江超¹,
谢长好^{1, 2},
王涛^{1, 2, ,}

1.
蚌埠医学院第一附属医院风湿免疫科，安徽蚌埠 233004
2.
慢性疾病免疫学基础与临床安徽省重点实验室，安徽蚌埠 233030

基金项目:

安徽省自然科学基金项目 2108085MH258

蚌埠医学院科研计划重点项目 2020byzd060

详细信息

通讯作者:
王涛，E-mail: bengbuwangtao@126.com

中图分类号: R593.241 R681.8
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出版历程
- 收稿日期: 2023-02-28
- 网络出版日期: 2023-09-13

Clinical study of ⁹⁹Technetium-methylenediphosphonate in the treatment of systemic lupus erythematosus complicated with osteonecrosis of the femoral head

1.
Department of Rheumatology and Immunology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探究⁹⁹锝-亚甲基二膦酸盐(⁹⁹Tc-MDP)治疗系统性红斑狼疮(SLE)合并股骨头坏死(ONFH)的有效性及安全性。方法选取2021年6月—2022年9月蚌埠医学院第一附属医院确诊为SLE合并ONFH(坏死组)及SLE不合并ONFH(对照组)患者共60例。其中坏死组(30例)，根据有无使用⁹⁹Tc-MDP分为常规组(15例)和联合组(15例)，对照组为30例；采用ELISA测定联合组与常规组患者治疗1个小疗程前后及对照组血浆骨保护素(OPG)、骨桥蛋白(OPN)浓度并进行比较分析，对联合组及常规组在1个大疗程治疗结束后进行随访，比较患者Harris评分、影像学变化及有无不良反应。结果 3组治疗前基线资料差异无统计学意义。1个小疗程治疗后：联合组患者治疗后血浆OPG水平较治疗前OPG水平升高、OPN水平较治疗前降低，差异有统计学意义。1个大疗程治疗后：(1)髋关节功能Harris评分联合组较常规组增加，联合组治疗后较治疗前明显增加，差异有统计学意义；常规组治疗后Harris评分较治疗前差异无统计学意义。(2)⁹⁹Tc-MDP治疗后影像学评价结果较治疗前无明显进展。(3)3组患者均未出现严重不良反应。结论 ⁹⁹Tc-MDP在常规用药基础上治疗SLE合并ONFH临床效果良好，且具有较高的安全性。
- ⁹⁹锝-亚甲基二膦酸盐 /
- 系统性红斑狼疮 /
- 股骨头坏死 /
- 骨保护素 /
- 骨桥蛋白
Abstract: Objective To investigate the efficacy and safety of ⁹⁹Technetium-methylenediphosphonate (⁹⁹Tc-MDP) in the treatment of systemic lupus erythematosus (SLE) complicated with osteonecrosis of the femoral head (ONFH). Methods A total of 60 patients diagnosed with SLE combined with ONFH (necrosis group) and SLE without ONFH (control group) were selected from June 2021 to September 2022 in the First Affiliated Hospital of Bengbu Medical College. Among them, the necrosis group (30 cases) was divided into the conventional group (15 cases) and the combined group (15 cases) according to whether ⁹⁹Tc-MDP was used. The concentrations of plasma osteoprotegerin (OPG) and osteopontin (OPN) were determined by ELISA before and after a short course of treatment between the combined group and the conventional group, and the control group were compared. Follow-up was conducted after a long course of treatment between the combination group and the conventional group, and the Harris score, imaging changes and adverse reactions were compared. Results There was no significant difference in baseline data between the three groups before treatment. After 1 short course of treatment: compared with before treatment, plasma OPG level increased and OPN level decreased in combination group after treatment, the differences were statistically significant. After 1 course of treatment: (1) The Harris score of hip function in the combined group was increased compared with the conventional group, and was significantly increased after treatment in the combined group compared with before treatment, the difference was statistically significant; There was no significant difference in Harris score between the conventional group after treatment and before treatment. (2) There was no significant improvement in imaging evaluation after ⁹⁹Tc-MDP treatment. (3) No serious adverse reactions were found in the three groups. Conclusion On the basis of routine medication, ⁹⁹Tc-MDP has good clinical effect and high safety in the treatment of systemic lupus erythematosus complicated with osteonecrosis of the femoral head.
- ⁹⁹Technetium-methylenediphosphonate /
- Systemic lupus erythematosus /
- Osteonecrosis of the femoral head /
- Osteoprotegerin /
- Osteopontin

HTML全文

图 1 SLE并发ONFH患者1个小疗程前后影像学图像

注：患者女性，37岁，A为患者治疗前T₁WI冠状位图像，B为患者治疗1个小疗程后T₁WI冠状位图像。图像显示：患者两侧股骨头内见斑片状长T₁信号，1个小疗程治疗后左侧股骨头较治疗前图像坏死的范围有所缩小。

Figure 1. Imaging images of patients with SLE complicated with ONFH before and after a small course of treatment

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图 2 SLE并发ONFH患者2个大疗程治疗前后影像学图像

注：患者女性，51岁，A为治疗前T₂WI横断位图像，B为2个大疗程(2年)治疗后T₂WI横断位图像。图像显示：双侧股骨头轻度变形，双侧髋关节腔内可见长T₂信号，双侧股骨头可见片状长T₂信号，脂肪抑制高信号，较前相仿，患者2年后股骨头坏死较2年前影像学表现未出现明显进展。

Figure 2. Imaging images of patients with SLE complicated with ONFH before and after two large courses of treatment

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表 1 各组系统性红斑狼疮患者基线资料比较

Table 1. Comparison of baseline data of patients with systemic lupus erythematosus in each group

组别	例数	性别(男性/女性，例)	年龄[M(P₂₅, P₇₅)，岁]	SLE病程[M(P₂₅, P₇₅)，年]	ONFH病程[M(P₂₅, P₇₅)，年]	平均激素用量[M(P₂₅, P₇₅)，mg/d]
常规组	15	2/13	37.00(31.00, 49.00)	7.00(4.00, 12.00)	1.00(0.25, 2.00)	10.00(5.00, 15.00)
联合组	15	4/11	32.00(29.00, 47.00)	5.00(3.00, 10.00)	2.00(0.50, 3.00)	10.00(7.50, 10.00)
对照组	30	2/28	37.00(29.00, 50.50)	3.00(0.95, 10.00)		10.00(7.50, 15.00)
统计值		3.462^a	1.094^b	1.211^b	-0.861^c	4.120^b
P值		0.177	0.579	0.546	0.389	0.127

组别	例数	胆固醇[M(P₂₅, P₇₅)，mmol/L]	甘油三酯[M(P₂₅, P₇₅)，mmol/L]	高密度脂蛋白[M(P₂₅, P₇₅)，mmol/L]	低密度脂蛋白[M(P₂₅, P₇₅)，mmol/L]	CRP [M(P₂₅, P₇₅)，mg/L]
常规组	15	3.45(2.96, 4.25)	1.16(0.65, 1.90)	1.02(0.93, 1.26)	1.86(1.61, 2.50)	9.10(1.90, 12.90)
联合组	15	4.23(3.33, 4.95)	1.26(0.96, 1.81)	1.04(0.86, 1.20)	2.32(1.74, 3.07)	14.05(2.80, 25.80)
对照组	30	4.14(3.57, 4.92)	1.48(1.13, 1.91)	1.10(0.80, 1.37)	2.62(1.81, 2.98)	6.30(0.98, 24.48)
统计值		2.713^b	1.146^b	0.056^b	2.731^b	1.172^b
P值		0.258	0.564	0.972	0.255	0.556
注：^a为χ²值，^b为H值，^c为Z值。

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表 2 联合组和常规组患者治疗前后Harris评分比较(x±s，分)

Table 2. Comparison of Harris scores before and after treatment between combination group and conventional group(x±s, points)

组别	例数	疼痛		功能		畸形、活动度		总分
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
联合组	15	26.00±5.07	30.00±5.35^a	24.67±6.23	30.67±2.92^a	5.47±1.06	6.20±0.78^a	56.13±11.10	67.13±7.17^a
常规组	15	24.67±5.16	25.33±5.15	22.60±4.88	23.13±4.37	5.13±0.74	5.13±0.83	52.27±9.04	53.60±8.64
t值		1.080	2.779	1.011	4.549	0.997	3.630	1.206	3.758
P值		0.289	0.010	0.321	0.001	0.327	0.001	0.238	0.001
注：与同组治疗前比较，^aP < 0.05。

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表 3 3组患者治疗前后OPG、OPN水平比较(x±s)

Table 3. Comparison of OPG and OPN levels in 3 groups before and after treatment(x±s)

组别	例数	OPG(ng/mL)		OPN(pg/mL)
组别	例数	治疗前	治疗后	治疗前	治疗后
联合组	15	333.31±136.50	405.71±141.26^b	19.75±9.70	16.56±10.77^b
常规组	15	501.28±197.05	443.13±162.09^b	18.32±10.66	21.87±6.34
对照组	30	463.58±219.72		16.229±7.34
统计量		3.151^a	-0.674^c	0.852^a	-1.645^c
P值		0.050	0.506	0.432	0.114
注：^a为F值，^c为t值；与治疗前比较，^bP < 0.05。

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