Thorne J C, Evans W K, Alison R E, Fournasier V
Am J Med. 1981 Nov;71(5):751-8. doi: 10.1016/0002-9343(81)90354-5.
Over a 15-year period, 12 patients were seen at the Ontario Cancer Institute in whom avascular necrosis of bone development after or during treatment for malignant lymphoma. All but one were treated with systemic chemotherapy that included high-dose intermittent corticosteroids. The average time of onset of symptoms was 34 months (range, eight of 72 months) after an average of 9.0 g of prednisone (range, 1.4 to 18.75 g). The one exception was a patient with Hodgkin's disease treated by pelvic radiation alone who had development of avascular necrosis of the femoral head within one month of irradiation. More than one joint was involved in 58 percent of patients. Six patients required surgery (usually hip replacement) but two patients had no evidence of deterioration over many years (average, seven years) and three patients had minimal symptoms easily controlled by mild analgesics up to six years after diagnosis. The evidence implicating corticosteroids in the development of avascular necrosis is presented and the various hypotheses of pathogenesis are reviewed. The predominance of Hodgkin's disease over non-Hodgkin's lymphomas (5:1) in this and other series and the identification of one patient with Hodgkin's disease with development of avascular necrosis within one month of radiotherapy treatment suggests that Hodgkin's disease itself may predispose to this condition.
在15年的时间里，安大略癌症研究所诊治了12例在恶性淋巴瘤治疗期间或治疗后出现骨发育性无血管坏死的患者。除1例患者外，其余所有患者均接受了包括大剂量间歇性皮质类固醇在内的全身化疗。症状出现的平均时间为平均服用9.0克泼尼松（范围为1.4至18.75克）后34个月（范围为8至72个月）。唯一的例外是一名仅接受盆腔放疗的霍奇金病患者，在放疗后1个月内出现了股骨头无血管坏死。58%的患者累及一个以上关节。6例患者需要手术（通常为髋关节置换），但有2例患者在多年（平均7年）内无病情恶化迹象，3例患者在诊断后长达6年症状轻微，通过轻度镇痛药即可轻松控制。文中呈现了皮质类固醇与无血管坏死发生相关的证据，并对各种发病机制假说进行了综述。在本系列及其他系列中，霍奇金病相对于非霍奇金淋巴瘤的优势比例为5:1，且有1例霍奇金病患者在放疗治疗后1个月内出现无血管坏死，这表明霍奇金病本身可能易引发这种情况。
