Lai Shih-Wei, Lin Cheng-Li, Liao Kuan-Fu
College of Medicine, China Medical University.
Department of Family Medicine, and China Medical University Hospital.
Medicine (Baltimore). 2020 Jan;99(3):e18585. doi: 10.1097/MD.0000000000018585.
The aim of this study was to assess a correlation between avascular necrosis of femoral head and oral corticosteroids use in the general population in Taiwan. A population-based case-control study was performed to analyze the database of Taiwan National Health Insurance Program. The study consisted of 3002 subjects aged 20 to 84 with newly diagnosed avascular necrosis of femoral head between 2000 and 2013 as the cases and 11279 sex-matched and age-matched subjects without avascular necrosis of femoral head as the matched controls. Use of oral corticosteroids was defined as subjects who had at least a prescription for oral corticosteroids before the index date. No use of oral corticosteroids was defined as subjects who did not have a prescription for oral corticosteroids before the index date. The logistic regression model revealed that subjects with avascular necrosis of femoral head were 1.65 times more likely to be exposed to oral corticosteroids than those subjects without avascular necrosis of femoral head (OR 1.65, 95% CI = 1.51-1.80). A sub-analysis revealed that there was a significant association between avascular necrosis of femoral head and increasing cumulative duration of oral corticosteroids for each additional month of use (OR 1.03, 95% CI = 1.02-1.03). A significant association is detected between avascular necrosis of femoral head and oral corticosteroids use in the general population in Taiwan. There is a duration-dependent effect of oral corticosteroids use on the risk of avascular necrosis of femoral head. Clinicians should be aware of the risk of avascular necrosis of femoral head when oral corticosteroids are prescribed for a long time.
本研究旨在评估台湾普通人群中股骨头缺血性坏死与口服糖皮质激素使用之间的相关性。我们进行了一项基于人群的病例对照研究，以分析台湾国民健康保险计划的数据库。该研究纳入了3002名年龄在20至84岁之间、于2000年至2013年期间新诊断为股骨头缺血性坏死的受试者作为病例组，以及11279名年龄和性别匹配、无股骨头缺血性坏死的受试者作为匹配对照组。口服糖皮质激素的使用定义为在索引日期之前至少有一次口服糖皮质激素处方的受试者。未使用口服糖皮质激素定义为在索引日期之前没有口服糖皮质激素处方的受试者。逻辑回归模型显示，患有股骨头缺血性坏死的受试者接触口服糖皮质激素的可能性是未患股骨头缺血性坏死受试者的1.65倍（比值比1.65，95%置信区间 = 1.51 - 1.80）。一项亚分析显示，股骨头缺血性坏死与口服糖皮质激素使用每增加一个月的累积持续时间增加之间存在显著关联（比值比1.03，95%置信区间 = 1.02 - 1.03）。在台湾普通人群中，检测到股骨头缺血性坏死与口服糖皮质激素使用之间存在显著关联。口服糖皮质激素使用对股骨头缺血性坏死风险存在持续时间依赖性效应。临床医生在长期开具口服糖皮质激素处方时应意识到股骨头缺血性坏死的风险。
