Blood and Marrow Transplant Program, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
Biol Blood Marrow Transplant. 2010 Sep;16(9):1231-6. doi: 10.1016/j.bbmt.2010.03.008. Epub 2010 Mar 17.
Exposure to corticosteroids increases the risks of avascular necrosis (AVN) of the bone after hematopoietic cell transplantation (HCT). However, whether this effect is dependent on the dose of corticosteroids is not well known. We conducted a case-controlled study, which included 74 recipients of autologous or allogeneic HCT with AVN and 147 controls without AVN that were matched by age, sex, and year of HCT to cases. Cases with AVN included 8 autologous HCT recipients, 58 myeloablative allogeneic HCT recipients, and 8 recipients of non-myeloablative allogeneic HCT. Corticosteroid exposure was expressed as cumulative doses of prednisone. Cases received higher cumulative doses of prednisone than controls, and among allogeneic HCT recipients, cases were more likely to have developed acute and chronic graft-versus-host disease (aGVHD, cGVHD). Cumulative dose of prednisone was an independent risk factor for AVN. Compared to no corticosteroid exposure, exposure to <3870 mg cumulative dose of prednisone was associated with 4.0 (95% confidence intervals, 1.5-11.2) times higher risk, 3870-9735 mg with 5.6 (2.1-15.2) times higher risk and >9735 with 8.6 (3.2-23.5) times higher risk of AVN. Exposure to higher doses of corticosteroids increases the risk of AVN in HCT recipients.
接受造血细胞移植（HCT）后，皮质类固醇暴露会增加骨缺血性坏死（AVN）的风险。然而，这种影响是否取决于皮质类固醇的剂量尚不清楚。我们进行了一项病例对照研究，该研究包括 74 例接受自体或同种异体 HCT 后发生 AVN 的患者和 147 例年龄、性别和 HCT 年份与病例相匹配的无 AVN 对照者。AVN 病例包括 8 例自体 HCT 受者、58 例清髓性同种异体 HCT 受者和 8 例非清髓性同种异体 HCT 受者。皮质类固醇暴露用泼尼松累积剂量表示。病例组接受的泼尼松累积剂量高于对照组，并且在同种异体 HCT 受者中，病例组更可能发生急性和慢性移植物抗宿主病（aGVHD、cGVHD）。泼尼松累积剂量是 AVN 的独立危险因素。与无皮质类固醇暴露相比，<3870mg 累积剂量的皮质类固醇暴露与 4.0 倍（95%置信区间，1.5-11.2）的更高风险相关，3870-9735mg 与 5.6 倍（2.1-15.2）的更高风险相关，而>9735mg 与 8.6 倍（3.2-23.5）的更高风险相关。暴露于更高剂量的皮质类固醇会增加 HCT 受者发生 AVN 的风险。
