Steroid-induced osteonecrosis in severe acute respiratory syndrome: a retrospective analysis of biochemical markers of bone metabolism and corticosteroid therapy.
Steroid-induced osteonecrosis in severe acute respiratory syndrome: a retrospective analysis of biochemical markers of bone metabolism and corticosteroid therapy.
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DOI：
10.1080/00313020600696231
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发表时间：
2006-06
期刊：
影响因子：
4.5
通讯作者：
Lam CW
中科院分区：
文献类型：
--
作者：
Chan MH;Chan PK;Griffith JF;Chan IH;Lit LC;Wong CK;Antonio GE;Liu EY;Hui DS;Suen MW;Ahuja AT;Sung JJ;Lam CW
我们使用骨代谢特异性生化标志物研究了大剂量皮质类固醇治疗对骨代谢的影响，以及香港一所大学教学医院严重急性呼吸综合征（SARS）患者骨坏死的患病率。根据世界卫生组织修订的SARS病例定义，对2003年3月10日至6月20日期间参与SARS流行的71例临床诊断为SARS的患者进行了研究。临床诊断通过血清学试验和/或分子生物学分析证实。使用从入院到出院的过程中从每名患者收集的连续凝结血液样品和随后在门诊诊所的随访，使用任意时间段回顾性分析骨代谢的生化标志物：（i）发热发作后第<10天;（ii）第28-44天;（iii）第51-84天;和（iv）第>90天。入院后进行膝关节和髋关节的磁共振成像，以评估这些SARS患者中骨坏死的患病率。采用受试者工作特征曲线与适当的检验统计量和斯皮尔曼等级相关系数与生化骨标志物比较，评估骨坏死发生的各种危险因素。骨代谢的生化标志物显示显著的骨吸收，如发热发作后第28-44天血清C-末端肽浓度（CTx）显著增加所证明。随着皮质类固醇剂量的逐渐减少，CTx从第51天开始恢复到先前的基线水平，而其他骨形成标志物、血清骨钙素和骨特异性碱性磷酸酶浓度（分别为OC和BALP）开始增加。后一效应在>90天后甚至更显著。7例患者出现骨坏死的放射学证据。该队列中骨坏死的患病率为9.9%。皮质类固醇总剂量> 1900 mg氢化可的松、>2000 mg甲基强的松龙、>13 340 mg氢化可的松等效皮质类固醇治疗和>18天皮质类固醇治疗被认为是随后发生骨坏死的显著危险因素。在该患者队列中，各种生化骨标志物之间也存在显著正相关。骨吸收和骨形成标志物均不能预测骨坏死的后续发展。长时间使用高剂量氢化可的松或甲基强的松龙被证明是骨坏死的一个重要危险因素。其患病率在这一队列中与文献中报道的SARS患者高剂量皮质类固醇治疗。第28-44天血清CTx升高与皮质类固醇使用时间一致。>51天血清OC和BALP的增加与皮质类固醇停药的时间一致。
We investigated the effect of massive doses of corticosteroid therapy on bone metabolism using specific biochemical markers of bone metabolism, and the prevalence of osteonecrosis in severe acute respiratory syndrome (SARS) patients at a university teaching hospital in Hong Kong. Seventy-one patients with a clinical diagnosis of SARS were studied according to the modified World Health Organization case definition of SARS who were involved in the SARS epidemic between 10 March and 20 June 2003. The clinical diagnosis was confirmed by serological test and/ or molecular analysis. Biochemical markers of bone metabolism were analysed retrospectively using serial clotted blood samples collected from each patient during the course of hospital admission to discharge and subsequent follow-up at out-patient clinic using the arbitrary time periods: (i) Day <10; (ii) Day 28-44; (iii) Day 51-84; and (iv) Day >90 after the onset of fever. Magnetic resonance imaging of the knee and hip joints were performed post-admission to evaluate the prevalence of osteonecrosis amongst these SARS patients. Various risk factors for the development of osteonecrosis were assessed using receiver operating characteristics curve comparison with appropriate test statistics and Spearman’s coefficients of rank correlation with biochemical bone markers. Biochemical markers of bone metabolism showed significant bone resorption as evidenced by a marked increase in serum C-terminal telopeptide concentration (CTx) from Day 28-44 after the onset of fever. With tapering down of corticosteroid dosage, CTx started to return to previous baseline level from Day 51 onwards, while other bone formation markers, serum osteocalcin and bone- specific alkaline phosphatase concentrations (OC and BALP, respectively), started to increase. The latter effect was even more marked after Day >90. Seven patients developed radiological evidence of osteonecrosis. The prevalence of osteonecrosis in this cohort was 9.9%. A total corticosteroid dosage of >1900mg hydrocortisone, >2000 mg methylprednisolone, >13 340 mg hydrocortisone-equivalent corticosteroid therapy, and >18 days on corticosteroid therapy were found to be significant risk factors for the subsequent development of osteonecrosis. There were also significant positive correlations amongst various biochemical bone markers in this patient cohort. Both bone resorption and formation markers were unable to predict the subsequent development of osteonecrosis. The use of high dose of hydrocortisone or methylprednisolone for an extended duration was shown to be a significant risk factor for osteonecrosis. Its prevalence in this cohort is comparable to those reported in the literature for SARS patients with high-dose corticosteroid therapy. The Day 28–44 increase in the serum CTx coincided with the timing of corticosteroid use. The Day >51 increase in serum OC and BALP coincided with the timing of corticosteroid withdrawal.
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影响因子：
4.4
作者：
RISTELI, L;RISTELI, J
通讯作者：
RISTELI, J
影响因子：
3
作者：
BIFFL, WL;MOORE, FA;BURCH, JM
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影响因子：
3.4
作者：
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影响因子：
39.2
作者：
POCOCK, NA;EISMAN, JA;HUQ, NL
通讯作者：
HUQ, NL
影响因子：
11.1
作者：
Chan, MHM;Wong, VWS;Lam, CWK
通讯作者：
Lam, CWK