儿童皮质类固醇相关骨硬化风险因素:一项国家数据库研究
Gabriella B Smith1, Nicole S Pham1, Amin Alayleh1
1Stanford University School of Medicine, Department of Orthopaedic Surgery, Division of Pediatric Orthopaedics, Stanford, CA, USA.
概括
患有某些疾病的儿科患者,包括急性淋巴细胞白血病和全身性红斑狼,在接受皮质类固醇治疗时面临更高的骨髓缩风险. 有针对性的查对于识别接受这些药物的高风险儿童至关重要.
科学领域:
- 儿科风湿病学 儿科风湿病学
- 儿科瘤学 儿科瘤学
- 儿科免疫学 儿科免疫学
背景情况:
- 皮质类固醇相关的骨 necrosis (CA-ONJ) 是一种严重的并发症,导致疼痛和关节崩.
- 虽然CA-ONJ在儿科患者中已知,但在各种疾病中识别高风险个体仍然具有挑战性.
- 这项研究旨在确定患有CA-ONJ风险较高的儿科患者群体,其治疗自身免疫性,炎症性和瘤性疾病的皮质类固醇治疗.
研究的目的:
- 为了确定儿童群体在皮质类固醇治疗后患有骨髓缩的高风险.
- 分析不同疾病的儿童与皮质类固醇相关的骨髓缩相关的风险因素.
主要方法:
- 使用Merative MarketScan研究数据库 (2007-2022) 进行的回顾性队列研究.
- 已确定接受口服或静脉注射皮质类固醇的儿科患者.
- 分析了人口统计,临床和处方数据,使用统计测试和Cox比例风险回归来确定骨髓缩的风险因素.
主要成果:
- 在接受皮质类固醇治疗的5,606,781名儿科患者中,有131人患有骨髓缩 (发病的平均时间为7.1个月).
- 骨髓缩的更高风险与急性淋巴细胞白血病 (HR=575.82),全身性红斑狼 (HR=106.41),克罗恩病 (HR=6.67),青少年异常性关节炎 (HR=4.62) 和固体器官移植 (HR=4.24) 相关.
- 其他显著的风险因素包括在皮质类固醇开始时的年龄较大,较长的总皮质类固醇处方时间,以及使用德克萨米他.
结论:
- 这项研究强调了接受高剂量皮质类固醇的儿科患者有针对性的查的必要性.
- 这些发现可以为接受皮质类固醇治疗的儿童提供多学科的方法和干预措施.
- 建议对潜在的查和干预方案进行进一步的研究.
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