Jenkinson Mark R J, Meek R M Dominic, Tate Rothwell, MacMillan Sandy, Grant M Helen, Currie Susan
University College London Hospitals, London, UK.
Queen Elizabeth University Hospital, Glasgow, UK.
Bone Joint Res. 2021 Jun;10(6):340-347. doi: 10.1302/2046-3758.106.BJR-2020-0414.R2.
Elevated levels of circulating cobalt ions have been linked with a wide range of systemic complications including neurological, endocrine, and cardiovascular symptoms. Case reports of patients with elevated blood cobalt ions have described significant cardiovascular complications including cardiomyopathy. However, correlation between the actual level of circulating cobalt and extent of cardiovascular injury has not previously been performed. This review examines evidence from the literature for a link between elevated blood cobalt levels secondary to metal-on-metal (MoM) hip arthroplasties and cardiomyopathy. Correlation between low, moderate, and high blood cobalt with cardiovascular complications has been considered. Elevated blood cobalt at levels over 250 µg/l have been shown to be a risk factor for developing systemic complications and published case reports document cardiomyopathy, cardiac transplantation, and death in patients with severely elevated blood cobalt ions. However, it is not clear that there is a hard cut-off value and cardiac dysfunction may occur at lower levels. Clinical and laboratory research has found conflicting evidence of cobalt-induced cardiomyopathy in patients with MoM hips. Further work needs to be done to clarify the link between severely elevated blood cobalt ions and cardiomyopathy. Cite this article: 2021;10(6):340-347.
循环钴离子水平升高与多种全身并发症有关，包括神经、内分泌和心血管症状。血液钴离子水平升高患者的病例报告描述了包括心肌病在内的严重心血管并发症。然而，此前尚未对循环钴的实际水平与心血管损伤程度之间的相关性进行研究。本综述审视了文献中关于金属对金属（MoM）髋关节置换术后血钴水平升高与心肌病之间关联的证据。已考虑低、中、高血钴水平与心血管并发症之间的相关性。血钴水平超过250μg/l已被证明是发生全身并发症的危险因素，已发表的病例报告记录了血钴离子严重升高患者的心肌病、心脏移植和死亡情况。然而，尚不清楚是否存在一个明确的临界值，较低水平时也可能发生心脏功能障碍。临床和实验室研究在MoM髋关节患者中发现了关于钴诱导心肌病的相互矛盾的证据。需要进一步开展工作以阐明血钴离子严重升高与心肌病之间的联系。引用本文：2021;10(6):340 - 347。
