糖皮质激素诱导骨坏死

Glucocorticoid-induced osteonecrosis

糖皮质激素诱导骨坏死(glucocorticoid-induced osteonecrosis,GIO)是非创伤性骨坏死最常见的病因,在长期接受糖皮质激素治疗的病人中有9%~40%可能发生骨坏死。糖皮质激素每日剂量和累积剂量越高、疗程越长,发生骨坏死风险越高,需要糖皮质激素治疗的各种基础疾病本身和不同的给药方式对骨坏死也有不同的影响。糖皮质激素诱导骨坏死的发病机制尚不明确,目前认为主要与糖皮质激素对骨的直接作用、凝血异常、血管内皮功能障碍、脂质代谢异常、遗传易感性以及基础疾病的压力累积有关。

Glucocorticoid-induced osteonecrosis(GIO)is the most common non-traumatic cause of osteonecrosis.The incidence of GIO is 9%-40%among patients receiving long-term glucocorticoid therapy.The risk of osteonecrosis increases with higher daily or cumulative dosage of glucocorticoid and prolonged duration.The underlying diseases which need glucocorticoid administration also have effects on osteonecrosis.To date,the pathogenesis of GIO is not clear.The current opinions of pathogenesis mainly include direct effects of glucocorticoid on bone,coagulation dysfunction,vascular endothelial cell dysfunction,lipid metabolism abnormality,genetic susceptibility and stress accumulation associated with underlying diseases.