Takahashi Shinji, Fukushima Wakaba, Kubo Toshikazu, Iwamoto Yukihide, Hirota Yoshio, Nakamura Hiroaki
Department of Public Health, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
J Orthop Sci. 2012 Nov;17(6):730-6. doi: 10.1007/s00776-012-0293-x. Epub 2012 Aug 29.
Cigarette smoking has been linked to an increased risk of nontraumatic osteonecrosis of the femoral head (ONFH) in previous studies. However, the effect of smoking amount, duration and cessation, and interaction with corticosteroids remains unclear. The purpose of this study was to precisely evaluate the effects of smoking and the interaction with corticosteroid use.
This was a multicenter, matched case-control study in Japan. Cases were defined as patients who were newly diagnosed with ONFH at an initial visit or during the previous year if they were referred patients. For each case, matched controls were selected from patients without ONFH. The matching conditions were sex, age, and ethnicity. A logistic regression model was used to compute odds ratios (OR) and 95 % confidence intervals (95 % CI).
We compared 72 cases with 244 matched controls. ORs were 3.89 (95 % CI 1.46-10.4) for current smokers, 3.89 (1.22-12.4) for smokers consuming more than 20 cigarettes per day, 4.26 (1.32-13.7) for smokers with 26 pack-years or more, and 3.11 (0.92-11.5) for smokers with a history of 29 years or more, with significant or marginally significant dose-response relationships. OR for current smokers was 10.3 among those who had never used corticosteroids and 1.56 among past or current corticosteroid users (P for interaction 0.010).
Our results revealed that heavier cigarette smoking was associated with a higher risk of ONFH. The elevated risk from cigarette smoking was markedly pronounced among those who had never used oral corticosteroids.
既往研究表明，吸烟会增加非创伤性股骨头坏死（ONFH）的风险。然而，吸烟量、持续时间和戒烟情况的影响，以及与皮质类固醇的相互作用仍不明确。本研究的目的是精确评估吸烟的影响以及与皮质类固醇使用的相互作用。
这是一项在日本进行的多中心、匹配病例对照研究。病例定义为初诊时新诊断为ONFH的患者，或如果是转诊患者，则为前一年新诊断为ONFH的患者。对于每个病例，从无ONFH的患者中选择匹配的对照。匹配条件为性别、年龄和种族。采用逻辑回归模型计算比值比（OR）和95%置信区间（95%CI）。
我们比较了72例病例和244例匹配对照。当前吸烟者的OR为3.89（95%CI 1.46 - 10.4），每天吸烟超过20支的吸烟者的OR为3.89（1.22 - 12.4），吸烟史达26包年或以上的吸烟者的OR为4.26（1.32 - 13.7），吸烟史达29年或以上的吸烟者的OR为3.11（0.92 - 11.5），存在显著或边缘显著的剂量反应关系。从未使用过皮质类固醇的当前吸烟者的OR为10.3，过去或当前使用皮质类固醇的吸烟者的OR为1.56（交互作用P值为0.010）。
我们的结果显示，重度吸烟与ONFH风险较高相关。在从未使用过口服皮质类固醇的人群中，吸烟导致的风险升高尤为明显。
