Osteonecrosis of the femoral head in sickle cell disease: prevalence, comorbidities, and surgical outcomes in California
Osteonecrosis of the femoral head in sickle cell disease: prevalence, comorbidities, and surgical outcomes in California
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DOI：
10.1182/bloodadvances.2017005256
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发表时间：
2017-07-01
期刊：
影响因子：
7.5
通讯作者：
Wun, Ted
中科院分区：
文献类型：
--
作者：
Adesina, Oyebimpe;Brunson, Ann;Wun, Ted
股骨头坏死 (ONFH) 是镰状细胞病 (SCD) 的一种常见并发症，在基于人群的队列研究中尚未得到充分描述。使用加州全州规划和发展办公室出院数据库（1991-2013），我们在考虑死亡竞争风险后估计了 ONFH 的累积发病率，并使用多变量 Cox 比例风险回归来确定与 ONFH 诊断相关的因素。我们还计算了髋关节置换手术后 30 至 90 天内再次入院或急诊科的比率。在我们的 SCD 队列中的 6237 名患者中，22% (n - 1356) 的 ONFH 患者中位年龄为 27 岁，23% (n 5 308) 的 ONFH 患者在中位年龄 36 岁时接受了髋关节置换手术。病情较严重的 SCD 患者（24%；较轻的患者为 8%）和既往有急性胸部综合征 (ACS) 的患者（18%；无 ACS 病史的 8%）到 30 岁时 ONFH 的累积发生率较高。从2003年到2013年，病情较严重（风险比[HR]，2.77；95%置信区间[CI]，2.38-3.23）或既往有ACS（HR，1.61；CI，1.35-1.91）的SCD患者更有可能发展为ONFH。 27% 的髋关节手术后患者在 30 天内再次入院，大部分是因为疼痛的血管闭塞危象。 ONFH 是一种常见的 SCD 并发症，随着年龄的增长而增加；正在进行的针对 SCD 引起的骨坏死的预防和有效非手术干预措施的研究必须仍然是研究的重点。
Osteonecrosis of the femoral head (ONFH) is a prevalent complication of sickle cell disease (SCD) that has not been well described in population-based cohort studies. Using California's Office of Statewide Planning and Development discharge databases (1991-2013), we estimated the cumulative incidence of ONFH after accounting for the competing risk of death and used a multivariable Cox proportional hazards regression to identify factors associated with ONFH diagnosis. We also calculated rates of readmissions to the hospital or emergency department within 30 to 90 days of hip replacement surgery. Of the 6237 patients in our SCD cohort, 22% (n - 1356) developed ONFH at a median age of 27 years, and 23% (n 5 308) of the patients with ONFH underwent hip replacement surgery at a median age of 36 years. The cumulative incidence of ONFH to age 30 years was higher among SCD patients with more severe disease (24%; vs 8% in less severe) and those with antecedent acute chest syndrome (ACS) (18%; vs 8% without prior history of ACS). From 2003 to 2013, SCD patients with more severe disease (hazard ratio [HR], 2.77; 95% confidence interval [CI], 2.38-3.23) or with antecedent ACS (HR, 1.61; CI, 1.35-1.91) were more likely to develop ONFH. Twenty-seven percent of post-hip surgery patients were readmitted within 30 days, mostly for painful vaso-occlusive crises. ONFH is a common SCD complication that increases with age; ongoing studies into prevention and effective nonsurgical interventions for SCD-induced osteonecrosis must remain a high research priority.