严重急性呼吸综合征患者康复期股骨头缺血性坏死和骨质疏松的影响因素  

Factors of avascular necrosis of femoral head and osteoporosis in SARS patients' convalescence

作　　者：李玉明 [1] 王世鑫 [2] 高宏生 [3] 王景贵 [4] 尉传社 [5] 陈礼明 [6] 惠武利 [3] 苑淑玲 [7] 焦振山 [7] 杨震 [2] 苏彬 [2] 

机构地区：[1]300162,天津,武警医学院附属医院内科 [2]300162,天津,武警医学院附属医院科研科 [3]武警医学院流行病学教研室 [4]300162,天津,武警医学院附属医院骨科 [5]300162,天津,武警医学院附属医院放射科 [6]300162,天津,武警医学院附属医院医教部 [7]天津市卫生局科教处

出　　处：《中华医学杂志》2004年第16期1348-1353,共6页National Medical Journal of China

基　　金：天津市科委重大科技攻关基金资助项目(033113311)

摘　　要：目的探讨严重呼吸综合征(SARS)患者康复期股骨头缺血性坏死和骨质疏松的影响因素。方法利用病历资料调查患者治疗期间的糖皮质激素用法和一般情况,在患者出院3个月后应用酶联免疫吸附实验(ELISA)和间接免疫荧光法(IFA)测定血清抗体IgG,应用磁共振(MRI)和定量超声(QUS)分别测定股骨头缺血性坏死和骨质疏松,统计分析采用Logistic多元回归法和协方差分析。结果全疗程使用的糖皮质激素总量平均为4949 mg±2959 mg,糖皮质激素应用天数平均为24 d±5 d,其应用天数主要集中在16-30 d,使用冲击疗法的病例有23例,其持续天数平均为8 d±4 d,减药速度平均为33 mg/d±26 mg/d。40例患者中,血清抗体IgG测定阴性4例,阳性36例,其吸光度值平均为0.91±0.24。股骨头坏死Ⅰ期有12例(双侧坏死9例,单纯左侧3例),无坏死患者例数28例;骨质疏松2例,骨密度减低30例,正常8例。QUS检查ZBUA平均为(-1.26±0.53),TBUA平均为(-1.49±0.59),Zvos平均为(-0.53±0.30),Tvos平均为(-0.65±0.05)。股骨头缺血性坏死的影响因素有后期活动量、糖皮质激素总量和糖皮质激素冲击疗法的持续天数;骨密度的影响因素有年龄、冲击疗法和糖皮质激素总量;骨结构和骨弹性的影响因素有冲击疗法、冲击疗法持续的天数;血清抗体IgG与患者康复期股骨头缺血性?Objective To explore the factors affecting the pathogenesis of avascular necrosis of femoral head and osteoporosis of SARS patients during convalescent stage. Methods The clinical data of 40 SARS patients, 12 males and 28 females, aged 29 ± 9, hospitalized from April to June 2003, were reviewed, targeted on the use of glucocorticoids. Three months after the discharge ELISA and indirect immunofluorescent antibody (IFA) assay were used to detect the serum IgG. Magnetic resonance imaging (MRI) was used to detect the damage of the head of femur and quantitative ultrasound ( QUS) was used to detect osteoporosis at the left heel. Results The average total dosage of methylprednisolone was (4949 ± 2959) mg, and the average course of treatment was (24 ± 5) days (16 to 30 days). Twenty - three patients underwent ictus therapy of corticosteroids for (8±4) days. The extenuation time of corticosteroid' dosage was (33 ±26) mg /d. Of the 40 patients, 36 were IgG positive with an average A value of (0.91±0. 24) and 4 patients were IgG negative. Twelve patients ( 30% ) were with type I avascular necrosis of femoral head, including 3 cases with unilateral left - necrosis and 9 cases of bilateral necrosis. The other 28 patients were without necrosis. Two patients were suffering from osteoporosis and 30 patients were with bone density decrement. The average Z values of the parameter BUA and VOS were ( - 1. 26± 0. 53) and ( - 0. 53 ± 0. 30) respectively. The corresponding T values of the parameter BUA and VOS were( -1. 49 ?.59) and ( -0.65 ±0.05) respectively. The influencing factors of femoral necrosis included the degree of healing activity, the dosage summation of corticosteroids, and length of ictus therapy. The influencing factors of bone density included age, dosage summation, and length of ictus therapy. The influencing factors of the bone fabric and flexibility included the use and length of ictus therapy. Statistics showed that serum IgG was not related with avascular necrosis of femoral head and osteoporosis. Concl

关 键 词：严重急性呼吸综合征 康复期 股骨头缺血性坏死 SARS 骨质疏松 糖皮质激素 

分 类 号：R511.9[医药卫生—内科学]