Motomura Goro, Yamamoto Takuaki, Miyanishi Keita, Kondo Kyoko, Hirota Yoshio, Iwamoto Yukihide
Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan.
J Rheumatol. 2008 Dec;35(12):2391-4. doi: 10.3899/jrheum.080416. Epub 2008 Nov 1.
Both abnormal lipid metabolisms and coagulopathy have been suggested to be associated with the development of steroid-induced osteonecrosis (ON). We examined plasma risk factors for development of steroid-induced ON in rabbits after prophylaxis with a lipid-lowering agent and/or an anticoagulant.
Seventy adult male rabbits were injected intramuscularly once with 20 mg/kg methylprednisolone acetate. Fifty-five rabbits received prophylaxis with probucol (a lipid-lowering agent; n = 20) or warfarin (an anticoagulant; n = 14) or both (n = 21). Probucol and warfarin were administered beginning 1 to 2 weeks prior to steroid injection. Two weeks after steroid injection, the bilateral femora and humeri were examined histopathologically for the presence of ON. Based on a logistic regression model, laboratory variables before steroid injection were assessed to determine whether they demonstrated any association with the risk of ON.
Twenty-one rabbits developed ON. In the univariate analyses, significant positive associations were observed between plasma concentrations of triglyceride and low-density lipoprotein and the risk of development of ON. In the multivariate model, only the plasma triglyceride level suggested a positive association. Even after adjusting for probucol and warfarin use, the plasma triglyceride level was still suggested to be a predictor for development of ON. Rabbits with higher baseline triglyceride levels had a more pronounced triglyceride increase in their response to steroids.
Our study suggests that, after prophylaxis with probucol and/or warfarin, plasma triglyceride level is associated with the development of steroid-induced ON in rabbits.
脂质代谢异常和凝血功能障碍均被认为与类固醇诱导的骨坏死（ON）的发生有关。我们研究了在给予降脂药物和/或抗凝剂预防后，兔类固醇诱导性ON发生的血浆危险因素。
70只成年雄性兔一次性肌肉注射20mg/kg醋酸甲泼尼龙。55只兔接受普罗布考（一种降脂药物；n = 20）或华法林（一种抗凝剂；n = 14）或两者（n = 21）预防。普罗布考和华法林在类固醇注射前1至2周开始给药。类固醇注射后两周，对双侧股骨和肱骨进行组织病理学检查以确定是否存在ON。基于逻辑回归模型，评估类固醇注射前的实验室变量，以确定它们是否与ON风险存在任何关联。
21只兔发生ON。在单因素分析中，观察到血浆甘油三酯和低密度脂蛋白浓度与ON发生风险之间存在显著正相关。在多变量模型中，只有血浆甘油三酯水平显示出正相关。即使在调整普罗布考和华法林的使用后，血浆甘油三酯水平仍被认为是ON发生的预测指标。基线甘油三酯水平较高的兔在对类固醇的反应中甘油三酯升高更为明显。
我们的研究表明，在使用普罗布考和/或华法林预防后，血浆甘油三酯水平与兔类固醇诱导性ON的发生有关。
