[Factors of avascular necrosis of femoral head and osteoporosis in SARS patients' convalescence].
OBJECTIVE
To explore the factors affecting the pathogenesis of avascular necrosis of femoral head and osteoporosis of SARS patients during convalescent stage.


METHODS
The clinical data of 40 SARS patients, 12 males and 28 females, aged 29 +/- 9, hospitalized from April to June 2003, were reviewed, targeted on the use of glucocorticoids. Three months after the discharge ELISA and indirect immunofluorescent antibody (IFA) assay were used to detect the serum IgG. Magnetic resonance imaging (MRI) was used to detect the damage of the head of femur and quantitative ultrasound (QUS) was used to detect osteoporosis at the left heel.


RESULTS
The average total dosage of methylprednisolone was (4949 +/- 2959) mg, and the average course of treatment was (24 +/- 5) days (16 to 30 days). Twenty-three patients underwent ictus therapy of corticosteroids for (8 +/- 4) days. The extenuation time of corticosteroid' dosage was (33 +/- 26) mg/d. Of the 40 patients, 36 were IgG positive with an average A value of (0.91 +/- 0.24) and 4 patients were IgG negative. Twelve patients (30%) were with type I avascular necrosis of femoral head, including 3 cases with unilateral left--necrosis and 9 cases of bilateral necrosis. The other 28 patients were without necrosis. Two patients were suffering from osteoporosis and 30 patients were with bone density decrement. The average Z values of the parameter BUA and VOS were (-1.26 +/- 0. 53) and (-0.53 +/- 0.30) respectively. The corresponding T values of the parameter BUA and VOS were (-1.49 +/- 0.59) and (-0.65 +/- 0.05) respectively. The influencing factors of femoral necrosis included the degree of healing activity, the dosage summation of corticosteroids, and length of ictus therapy. The influencing factors of bone density included age, dosage summation, and length of ictus therapy. The influencing factors of the bone fabric and flexibility included the use and length of ictus therapy. Statistics showed that serum IgG was not related with avascular necrosis of femoral head and osteoporosis.


CONCLUSIONS
The incidence rates of avascular necrosis of femoral head and of osteoporosis were higher in convalescent SARS patients than in general population. The influencing factors of femoral necrosis included the degree of healing activity, the dosage summation of corticosteroids, and length of ictus therapy. The influencing factors of bone density included age, dosage summation, and length of ictus therapy. The influencing factors of the bone fabric and flexibility included the use and length of ictus therapy. Statistics showed that serum IgG was not related with avascular necrosis of femoral head and osteoporosis. SARS virus may not affect the pathogenesis of avascular necrosis of femoral head and osteoporosis.
Li
Yu-ming
YM
The Affiliated Hospital of Medical College of Chinese People's Armed Police Forces, Tianjin 300162, China.
Wang
Shi-xin
SX
Gao
Hong-sheng
HS
Wang
Jing-gui
JG
Wei
Chuan-she
CS
Chen
Li-ming
LM
Hui
Wu-li
WL
Yuan
Shu-ling
SL
Jiao
Zhen-shan
ZS
Yang
Zhen
Z
Su
Bin
B
D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D015519:Bone Density / Q000187:drug effects; D002681:China / Q000453:epidemiology; D003289:Convalescence; D005260:Female; D005271:Femur Head Necrosis / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects*; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D045169:Severe Acute Respiratory Syndrome / Q000150:complications / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone