Kao Feng-Chen, Hsu Yao-Chun, Lin Chien-Fu Jeff, Lo Ying-Ying, Tu Yuan-Kun
Department of Orthopaedics, E-Da Hospital, Kaohsiung, Taiwan.
School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan.
PLoS One. 2017 Jan 26;12(1):e0169468. doi: 10.1371/journal.pone.0169468. eCollection 2017.
We aimed to investigate whether and how corticosteroid use was associated with serious hip arthropathy.
This population-based cohort study analyzed the Taiwan National Health Insurance Research Database and screened the one-million random sample from the entire population for eligibility. The steroid cohort consisted of 21,995 individuals who had used systemic corticosteroid for a minimum of 6 months between January 1, 1997 and December 31, 2006. They were matched 1:1 in propensity score on the index calendar date with controls who never used steroid. All participants were followed up until occurrence of serious hip arthropathy that required arthroplasty, withdrawal from the national health insurance, or the end of 2011. Surgical indication was classified as fracture-related and -unrelated. The cumulative incidence of hip arthroplasty was estimated by the Kaplan Meier method. The association with steroid exposure was explored by the Cox proportional hazard model.
Cumulative incidences of hip arthroplasty after 12 years of follow-up were 2.96% (95% confidence interval [CI], 2.73-3.2%) and 1.34% (95% CI, 1.2-1.51%) in the steroid users and non-users, respectively (P<0.0001). The difference was evident in fracture-related arthroplasty with 1.89% (95% CI, 1.71-2.09%) versus 1.10% (95% CI, 0.97-1.25%), but more pronounced in fracture-unrelated surgery, 1.09% (95% CI, 0.95-1.24%) versus 0.24% (95% CI, 0.19-0.32%). Multivariate-adjusted Cox regression analysis confirmed steroid use was independently associated with both fracture-related (adjusted hazard ratio [HR], 1.65; 95% CI, 1.43-1.91) and unrelated arthroplasty (adjusted HR, 4.21; 95% CI, 3.2-5.53). Moreover, the risk for fracture-unrelated arthropathy rose with steroid dosage, as the adjusted HR increased from 3.30 (95% CI, 2.44-4.46) in the low-dose subgroup, 4.54 (95% CI, 3.05-6.77) in intermediate-dose users, to 6.54 (95% CI, 4.74-9.02) in the high-dose counterpart (Ptrend<0.0001).
Corticosteroid use is associated with long-term risk of hip arthroplasty, particularly for fracture-unrelated arthropathy.
我们旨在研究使用皮质类固醇激素是否以及如何与严重髋关节病相关联。
这项基于人群的队列研究分析了台湾国民健康保险研究数据库，并从整个人口中筛选出100万随机样本以确定其是否符合条件。类固醇激素队列由21995名在1997年1月1日至2006年12月31日期间至少使用过6个月全身性皮质类固醇激素的个体组成。他们在索引日历日期按倾向得分1:1与从未使用过类固醇激素的对照组进行匹配。所有参与者均接受随访，直至发生需要进行关节置换术的严重髋关节病、退出国民健康保险或2011年底。手术指征分为与骨折相关和与骨折无关两类。采用Kaplan-Meier方法估计髋关节置换术的累积发病率。通过Cox比例风险模型探讨与类固醇激素暴露的关联。
随访12年后，类固醇激素使用者和非使用者中髋关节置换术的累积发病率分别为2.96%（95%置信区间[CI]，2.73 - 3.2%）和1.34%（95%CI，1.2 - 1.51%）（P<0.0001）。在与骨折相关的关节置换术中差异明显，分别为1.89%（95%CI，1.71 - 2.09%）和1.10%（95%CI，0.97 - 1.25%），但在与骨折无关的手术中更为显著，分别为1.09%（95%CI，0.95 - 1.24%）和0.24%（95%CI，0.19 - 0.32%）。多变量调整后的Cox回归分析证实，使用类固醇激素与与骨折相关的（调整后风险比[HR]，1.65；95%CI，1.43 - 1.91）和与骨折无关的关节置换术（调整后HR，4.21；95%CI，3.2 - 5.53）均独立相关。此外，与骨折无关的关节病风险随着类固醇激素剂量的增加而上升，低剂量亚组的调整后HR从3.30（95%CI，2.44 - 4.46）增加到中等剂量使用者的4.54（95%CI，3.05 - 6.77），再到高剂量使用者的6.54（95%CI，4.74 - 9.02）（P趋势<0.0001）。
使用皮质类固醇激素与髋关节置换术的长期风险相关，尤其是与骨折无关的关节病。
