类固醇治疗重症肌无力诱发的缺血性股骨头坏死(附9例临床分析)

用类固醇治疗900例重症肌无力患者,结果出现9例股骨头缺血性坏死,发生率为1%。男6例,女3例,年龄22～60岁。骨坏死的发生与开始3个月用类固醇的总量大小有关,而与总疗程无关。在开始3个月的总量<3.6g的725例患者中,无1例发生骨坏死者,而在≥3.6g的175例患者中骨坏死9例,高达5%,二者有显著性差异(P<0.001)。经1～12年的随访,发现早期停止用药可使病情稳定且偶见改善。早期作骨减压术可使症状消失。为防止这一合并症的发生,应尽量减少开始3个月激素的总量,特别是对30岁以上的患者尤其应引起重视。

STER0ID-INDUCED AVASCULAR NECROSIS OF FEMORAL HEAD IN CASES OF MYASTHENIA GRAVIS:AN ANALYSIS OF NINE CASES

Out of the 900 cases of myasthenia gravis treated at this hospital over theepast 12 years, 9 developed avascular necrosis of the femoral head, the incidencbeing 1%. 6 of these patients were male and 3 were female, ranging in age from22 to 60 years. The age of onset was mostly from 22 to 60. We found that thedevelopment of this necrosis was related to the dosage of drug (prednisone)administered during the first three months of treatment: the higher the dosage, thegreater the possibility of developing the necrosis, as all the above 9 patients wereamong the 175 patients who received a total dosage of more than 3600mg duringthe first three months, while none of the 725 patients who were given less thanthat amount ever developed this complication. In order to prevent avascular necrosisof the femoral head, steroid therapy for myasthenia gravis should be put under strictsupervision of the physician.