Adesina Oyebimpe, Brunson Ann, Keegan Theresa H M, Wun Ted
Division of Hematology, Stanford University School of Medicine, Stanford, CA; and.
Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA.
Blood Adv. 2017 Jul 11;1(16):1287-1295. doi: 10.1182/bloodadvances.2017005256.
Osteonecrosis of the femoral head (ONFH) is a prevalent complication of sickle cell disease (SCD) that has not been well described in population-based cohort studies. Using California's Office of Statewide Planning and Development discharge databases (1991-2013), we estimated the cumulative incidence of ONFH after accounting for the competing risk of death and used a multivariable Cox proportional hazards regression to identify factors associated with ONFH diagnosis. We also calculated rates of readmissions to the hospital or emergency department within 30 to 90 days of hip replacement surgery. Of the 6237 patients in our SCD cohort, 22% (n = 1356) developed ONFH at a median age of 27 years, and 23% (n = 308) of the patients with ONFH underwent hip replacement surgery at a median age of 36 years. The cumulative incidence of ONFH to age 30 years was higher among SCD patients with more severe disease (24%; vs 8% in less severe) and those with antecedent acute chest syndrome (ACS) (18%; vs 8% without prior history of ACS). From 2003 to 2013, SCD patients with more severe disease (hazard ratio [HR], 2.77; 95% confidence interval [CI], 2.38-3.23) or with antecedent ACS (HR, 1.61; CI, 1.35-1.91) were more likely to develop ONFH. Twenty-seven percent of post-hip surgery patients were readmitted within 30 days, mostly for painful vaso-occlusive crises. ONFH is a common SCD complication that increases with age; ongoing studies into prevention and effective nonsurgical interventions for SCD-induced osteonecrosis must remain a high research priority.
股骨头坏死（ONFH）是镰状细胞病（SCD）的一种常见并发症，在基于人群的队列研究中尚未得到充分描述。利用加利福尼亚州全州规划与发展办公室的出院数据库（1991 - 2013年），我们在考虑死亡竞争风险后估计了ONFH的累积发病率，并使用多变量Cox比例风险回归来确定与ONFH诊断相关的因素。我们还计算了髋关节置换手术后30至90天内再次入院或前往急诊科的比率。在我们的SCD队列中的6237名患者中，22%（n = 1356）在中位年龄27岁时发生了ONFH，其中23%（n = 308）的ONFH患者在中位年龄36岁时接受了髋关节置换手术。在病情更严重的SCD患者（24%；病情较轻者为8%）和有既往急性胸部综合征（ACS）的患者（18%；无ACS病史者为8%）中，到30岁时ONFH的累积发病率更高。从2003年到2013年，病情更严重的SCD患者（风险比[HR]，2.77；95%置信区间[CI]，2.38 - 3.23）或有既往ACS的患者（HR，1.61；CI，1.35 - 1.91）更有可能发生ONFH。27%的髋关节置换术后患者在30天内再次入院，主要是因为疼痛性血管闭塞危象。ONFH是一种常见的SCD并发症，其发病率随年龄增长而增加；针对SCD引起的骨坏死的预防和有效的非手术干预的持续研究必须仍然是一个高度优先的研究事项。
