ステロイド依存性気管支喘息症例の病的骨折と皮質骨傷害の検討

In a previous study, we demonstrated that chronic administration of systemic glucocorticoids decreases cortical bone mineral density (BMD) and induces development of pathologic fractures in asthmatic patients. To investigate cortical bone porosity due to glucocorticoids, we studied cortical bone volume, BMD, bone strength, and fractures in patients with asthma in this report. A total of 82 postmenopausal asthmatic patients were enrolled in the study. Vertebral fractures were diagnosed via plain spinal radiograms. Peripheral quantitative computed tomography (pQCT) was used to measure cortical BMD, relative cortical volume, and Strength Strain Index (SSI). Multiple regression analysis, Student's t test, and other statistical analyses were performed. Patients with systemic glucocorticoids therapy had lower cortical BMD, relative cortical volume, SSI, and more number of vertebral fractures than patients without it. Lifetime cumulative dose of glucocorticoids was related to cortical BMD, relative cortical volume, SSI, and the number of vertebral fractures. The cortical volumedensity relationship appeared to remain constant regardless of systemic glucocorticoid administration. The number of vertebral fractures correlated highly with cortical BMD, relative cortical volume, and SSI at the radius. In conclusion, systemic glucocorticoid administration decreases cortical bone density, cortical bone volume, and bone strength. G lucocorticoid administration appears to be responsible for the process of cortical bone porosity at both endosteal and intracortical sites. Given that both cortical bone density and volume provide bone strength, cortical bone porosity was seen to contribute to glucocorticoid - induced bone strength loss and fractures.【目的】骨強度には皮質骨の状態が主に関与するため，全身ステロイド療法に伴う病的骨折と皮質骨障害について検討した。【方法】閉経後女性気管支喘息患者82例で，ステロイド依存性群と非依 存群において，椎体骨折数，槙骨皮質骨骨密度，皮質骨容量，骨強度（SSI）をⅩ線側面像とpQCTを用いて検討した。 【結果】ステロイド依存群はステロイド非依存群に比べて，椎体圧迫骨折数は有意に多く，榛骨皮質骨骨密度，皮質骨容積比，骨強度は各々有意に低下していた。また，皮質骨骨密度と容積は一定の割合で減少していた。椎体圧迫骨折数は皮質骨骨密度，皮質骨容積比，骨強度の全てと高い相関を認めた。 【結論】ステロイド依存性気管支暗息症例においては，皮質骨の骨 密度と容量が同時に減少して骨強度が減少することによって，病的骨折が発症すると考えられた

A case of systemic lupus erythematosus (SLE) associated with disseminated intravascular coagulation (DIC)

播種性血管内凝固症候群（DIC）を合併した全身性エリテマトーデス（SLE）を経験したので報告する。症例は73歳女性。64歳時慢性関節リウマチ（RA）と診断された。1999年1月食欲低下を訴え当科受診した。血小板減少、FDP高値、PT上昇等よりDIC発症を疑った。膠原病では凝固系の異常を認めるが、本症例では凝固系が完進しDICを来したと考えられた。 本症例はリウマチ因子陽性であったが、朝のこわばり等典型的なRAの所見に乏しく他の膠原病の合併を疑い、腎障害、血小板減少、抗Sm抗体、抗核抗体陽性よりSLEと診断した。A case of disseminated intravascular coagulation (DIC) in a patient with systemic lupus erythematosus (SLE) was described. A 73-year-old female was diagnosed as having rheumatoid arthritis when she was 64 years old. In Jan, 1999, the patient was admitted to our hospital with the complaint of loss of appetite. She was suspected of DIC because of thrombocytopenia, increased fibrin degradation product and prolonged prothrombin test. Abnormality in coagulation system is recognized in collagen disease. In this case coagulation system was activated and DIC occurred. In this case rheumatoid factor was positive. But she was suspected of complicating other collagen disease because she was poor in typical characteristics of rheumatoid arthritis, such as morning stiffness. SLE was diagnosed on the basis of renal injury, thrombocytopenia, positive anti-Sm antibody and positive antinuclaer antibody in this case

Two male steroid-dependent asthmatics treated with etidronate

男性のステロイド依存性気管支喘息患者にエチドロネートを4年間の長期間にわたり投与した経験を得たので報告する｡症例は,男性のステロイド依存性気管支喘息で,エチドロネート200mg/日･14日間投与を4ケ月おきに4年間にわたり反復投与し,活性型ビタミンD製剤 (VD)投与と併用した2例と,活性型VD製剤を単独授与した2例｡椎体圧迫骨折数,境骨耗骨密度,海綿骨骨密度,皮質骨骨密度について,椎体X線像,PQCT(Stratec XCT960)を用いて4ケ月毎に測定し,48ケ月後の効果を検討した｡エチドロネートを投与した症例1では,総骨密度と海綿骨はやや増加を認め皮質骨密度は減少していた｡エチドロネートを授与した症例2では,総骨密度,海綿骨,皮質骨密度はいずれも減少を認めたが,VD単独投与した2例よりもやや減少が抑制されていたようであった｡VD単独投与した2例ではいずれの項目も減少を認めた｡これらの症例からは,エチドロネートは男性のステロイドによる骨傷害にも有効と考えられたが,現在投与継続途中であり,今後さらに検討を続ける必要がある｡We report an experience about administration of etidronate to male steroid-dependent asthmatics for a long time. For 4 years, two men with steroid-dependent asthma were treated with etidronate (200 mg / day, for 14 days) every 4 months and 25-hydroxyvitamin D3 (VD) together, and two patients were treated with VD alone. Vertebral fractures were evaluated by the lateral spinal X-ray films, and radial total bone mineral density (BMD) , trabecular BMD and the cortical BMD were measured by pQCT (Stratec XCT960) every four months. Trabecular and total BMD increased but cortical BMD decreased in the case 1 who was treated with both etidronate and VD. In the case 2 with etidronate and VD treatments, total and trabecular BMD decreased, but reduction of these indices seemed to be more suppressed than that in two patients with VD alone. According to these experiences, etidronate may be effective against the steroid-induced bone injury in men. Since periods treatment are not en-ough long to evaluate therapeutic effect of etid-ronate, we will have to continue the examination of these cases further more from now on