혈액질환 환자에서 대퇴골두 무혈성 괴사의 위험인자
Risk Factors for Osteonecrosis of the Femoral Head in Patients with Heamatologic diseases
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목적: 혈액질환 환자를 대상으로 대퇴골두 무혈성괴사가 발생한 군과 발생하지 않은 군을 비교 분석하여 대퇴골두 무혈성괴사 와 연관된 위험인자를 밝혀 보고자 한다. 대상 및 방법: 1994년 1월 1일부터 2007년 5월 31일까지 혈액종양 내과에서 입원 치료한 혈액질환 환자를 대상으로 대퇴골 두 무혈성 괴사가 발생한 군(54명)과 발생하지 않은 군(54명)을 대상으로 골수이식의 종류, 이식편 대 숙주질환, 전신 방사선 조사, 스테로이드 사용량 등을 위험 요소로 분석하였다. 결과: 복합회귀분석에서 위험 요소 중 총 스테로이드 사용량 1.5 g/BMI 이상인 경우 유의한 위험인자로 분석되었다. 골수 이식 의 시행여부와 전신방사선 조사 여부는 두 군에서 통계적으로 유의하지 않은 결과를 보였다. 골수 이식을 시행한 경우에 복합회 귀분석에서 이식편 대 숙주질환의 발생 유무와 동종이식의 시행여부를 조사해 보았을 때 통계적으로 유의하지 않은 결과를 보 였다. 결론: 혈액 질환 환자에서 1.5g/BMI 이상의 스테로이드를 사용한 경우는 대퇴골두 무혈성 괴사의 가능성이 높으므로 주의 깊은 추시가 필요하다.
Abstract
Purpose: We aimed to clarify the risk factors associated with the development of ONFH by comparing patients with hematologic diseases and osteonecrosis of the femur head (ONFH) to those patients without ONFH and who have hematologic diseases Materials and Methods: The study population was limited to the patients admitted to our Hematology-Oncology department from 1 January 1994 to 31 May 2007. The patients were divided into 2 groups (those with ONFH, 54 patients and those without ONFH, 54 patients) and the risk factors for ONFH were evaluated by a comparative analysis. We analyzed the effect of a history of bone marrow transplantation (BMT), graft-versus-host disease (GVHD), total body radiation (TBI) and the amount of steroid used as the risk factors for ONFH. Results: On the multiple logistic regression analysis, a total steroid use of >1.5 g/BMI was statistically identified as a significant risk factor for ONFH. The history of BMT and TBI were not statistically correlated with the development of ONFH. Among the patients with BMT, allogenic BMT and a history of GVHD were not statistically correlated with the development of ONFH on the multiple logistic regression analysis. Conclusion: Patients with hematologic diseases and who have used steroid >1.5g/BMI should carefully observed because they are more likely to develop ONFH.
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