Woo K, Emery J, Peabody J
Department of Pediatrics, Loma Linda University Medical Center, CA 92354.
Pediatrics. 1994 Mar;93(3):417-20.
Infants awaiting heart transplantation for congenital heart disease frequently require prostaglandin E1 (PGE1) infusion for prolonged periods. As a result, complications of prolonged PGE1 infusion, such as cortical hyperostosis, are being encountered more commonly.
To determine the incidence and severity of cortical hyperostosis in newborns requiring prolonged PGE1 infusion.
Chest radiographs of 86 infants receiving PGE1 infusion awaiting heart transplantation were reviewed. The chest radiographs were graded for the severity of cortical hyperostosis (no bony changes, minimal hyperostosis, or severe hyperostosis). Duration of PGE1 infusion, total PGE1 dose, and highest alkaline phosphatase were recorded for each patient. Infants were arbitrarily divided into three groups according to the duration of PGE1 infusion (< 30 days, 30 to 60 days, > 60 days).
Fifty-three of the 86 infants (62%) had radiologic evidence of cortical hyperostosis. Forty-two of 80 infants (53%) had elevated alkaline phosphatase. The percentage of infants with hyperostosis increased with increasing duration of PGE1 infusion (42% at < 30 days; 87% at 30 to 60 days; 100% at > 60 days). The incidence and severity of cortical hyperostosis were related (by Kruskal-Wallis) to the duration of PGE1 infusion (P < .0001) and the total dose of PGE1 received (P < .0001). The highest alkaline phosphatase levels were observed in infants with the most severe grades of hyperostosis (P < .0001). The percentage of infants with elevated alkaline phosphatase increased with greater severity of hyperostosis (26% of infants with no bony changes, 59% with minimal changes, and 85% with severe changes). Two infants had symptomatic bone tenderness or swelling mimicking osteomyelitis.
It is concluded that cortical hyperostosis is a frequent, often asymptomatic, side effect of prolonged PGE1 infusion that should be evaluated in any infant on long-term PGE1 therapy. When symptoms occur in infants awaiting transplantation, osteomyelitis must be excluded rapidly to avoid an unnecessary delay in transplantation.
因先天性心脏病等待心脏移植的婴儿常常需要长时间输注前列腺素E1（PGE1）。因此，长时间输注PGE1的并发症，如皮质骨增生，越来越常见。
确定需要长时间输注PGE1的新生儿中皮质骨增生的发生率和严重程度。
回顾了86例接受PGE1输注等待心脏移植的婴儿的胸部X光片。根据皮质骨增生的严重程度（无骨质改变、轻度增生或重度增生）对胸部X光片进行分级。记录每位患者的PGE1输注持续时间、PGE1总剂量和最高碱性磷酸酶水平。根据PGE1输注持续时间（<30天、30至60天、>60天）将婴儿任意分为三组。
86例婴儿中有53例（62%）有皮质骨增生的影像学证据。80例婴儿中有42例（53%）碱性磷酸酶升高。随着PGE1输注持续时间的增加，有增生的婴儿百分比增加（<30天时为42%；30至60天时为87%；>60天时为100%）。皮质骨增生的发生率和严重程度与PGE1输注持续时间（Kruskal-Wallis检验，P<.0001）和接受的PGE1总剂量（P<.0001）相关。在增生最严重的婴儿中观察到最高的碱性磷酸酶水平（P<.0001）。碱性磷酸酶升高的婴儿百分比随着增生严重程度的增加而增加（无骨质改变的婴儿中为26%，轻度改变的为59%，重度改变的为85%）。两名婴儿有类似骨髓炎的有症状的骨压痛或肿胀。
得出结论，皮质骨增生是长时间输注PGE1常见的、通常无症状的副作用，对于任何接受长期PGE1治疗的婴儿都应进行评估。当等待移植的婴儿出现症状时，必须迅速排除骨髓炎，以避免移植的不必要延迟。
