质子抑制剂的使用和风湿性疾病患者的骨健康:一个横截面研究
Andriko Palmowski1, Gabriela Schmajuk2, Jinoos Yazdany2
1Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Division of Rheumatology, University of California San Francisco, San Francisco, CA.
质子抑制剂 (PPI) 的使用可能会降低炎症性类风湿性疾病患者的骨矿物密度 (BMD),特别是与葡萄糖皮质类药物 (GCs) 结合使用时. 骨微型架构,通过状骨评分 (TBS) 测量,没有显著影响.
科学领域:
- 类风湿病学 类风湿病学
- 药理学 药理学是指药理学的学科.
- 骨的新陈代谢 骨的新陈代谢
背景情况:
- 质子抑制剂 (PPI) 广泛用于与酸有关的疾病.
- 它们对骨健康的长期影响,特别是在患有炎症性风湿性和肌肉骨疾病 (iRMDs) 的患者中,需要进一步研究.
- 葡萄糖皮质醇 (GCs) 也常用于iRMD,已知会影响骨密度.
研究的目的:
- 评估PPI使用对iRMD患者骨矿物密度 (BMD) 和骨微架构 (骨骨分数,TBS) 的影响.
- 为了确定这种效应是否受到同时使用GC的调节.
主要方法:
- 从一个潜在的单中心队列 (2015-2022) 中对1495名患有iRMD的患者进行横截面分析.
- 评估 BMD (腰椎,大腿部) 和 TBS.
- 使用逆概率加权来调整包括年龄,性别,BMI,GC剂量和CRP水平在内的混因素.
主要成果:
- 与非使用者相比,PPI使用者在脊椎和大腿部显示出较低的BMD.
- 这种关联仅在同时使用GCs>7.5 mg/d的普得尼松等效剂的患者中具有意义.
- 在PPI使用者和非使用者之间没有观察到TBS的显著差异.
结论:
- 使用PPI与iRMD患者的骨质量减少有关,这种效应可能会因同时高剂量GC治疗而加剧.
- PPI似乎影响了骨硬化,而不是骨微架构.
- 建议仔细考虑PPI的适用性,对于在GC上的iRMD患者.
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