这项研究旨在调查血液钴明显升高的髋关节置换患者自我报告的神经毒性和认知缺陷的患病率。
病例组包括53例使用金属对金属(MoM)植入物的患者,并且有血液Co≥20μg/L的病史,中位时间为3年(四分位距,2-5年)。对照组包括53例陶瓷对陶瓷假体,血液Co<1μg/L的患者。中位年龄为67岁(四分位间距,60-74岁)。参与者完成了神经毒性症状清单-60,糖尿病神经病变评分,DouleurNeuropathique-10和系统症状清单,并接受了迷你精神状态检查。
比较了MoM和陶瓷对陶瓷组,结果如下:神经毒性症状清单-60(中位数):认知缺陷(2.0对1.9;P=0.002),胸部投诉(1.3对1.3;P=0.042),平衡紊乱(1.3对1.0;P<0.001),睡眠障碍(2.7对2.0;P=0.004),心境障碍(2.0对1.5;P=0.001),感觉运动障碍(1.6对1.2;P<0.001),身体投诉(2.0对1.4;P=0.009),疲劳(2.0对1.6;P=0.001),和总分(108对90;P<0.001);异常糖尿病神经病变评分/Douleur神经病变-10(%):60.3/13.2对24.5/1.9(P<0.001/P=0.028)。全身症状清单(百分比):感觉寒冷(37.7vs.17;P=0.01),体重增加(18.9对1.9;P=0.008),金属味(26.4对3.8;P=0.002),视力恶化(37.7对15.1;P=0.008)和听力恶化(24.5对7.5;0.032),踝关节肿胀(32.1对7.5;P=0.002),劳累时呼吸短促(9.4对5.7;P=0.015),和全身性皮疹(28.3对7.5;P=0.01);和简易精神状态检查(中位数):29对30(P=0.017)。MoM组的患者意识到他们的高钴水平,并表现出更高的多报症状倾向(P<0.001),这可能会导致更高的分数。
MoM患者报告多种症状的频率明显较高,但未观察到临床上显着的神经毒性(可能是由于短时间暴露于升高的钴)。重复血液Co≥20μg/L测量的患者应在随访时询问可能的全身健康投诉。
This study aimed to investigate the prevalence of self-reported neurotoxicity and cognitive defects in hip replacement patients with markedly raised blood cobalt.
Case group comprised 53 patients with metal-on-metal (MoM) implants and a history of blood Co ≥20 μg/L for a median of 3 years (interquartile range, 2-5 years). The control group comprised 53 patients with ceramic-on-ceramic prostheses and blood Co <1 μg/L. Median age was 67 years (interquartile range, 60-74 years). The participants completed the Neurotoxic Symptom Checklist-60, Diabetic Neuropathy Score, Douleur Neuropathique-10, and Systemic Symptom Checklist, and underwent the Mini-Mental State Examination.
The MoM and ceramic-on-ceramic groups were compared, the results were as follows: Neurotoxic Symptom Checklist-60 (median): cognitive defects (2.0 versus 1.9; P = 0.002), chest complaints (1.3 versus 1.3; P = 0.042), balance disturbances (1.3 versus 1.0; P < 0.001), sleep disturbances (2.7 versus 2.0; P = 0.004), mood disorders (2.0 versus 1.5; P = 0.001), sensorimotor disorders (1.6 versus 1.2; P < 0.001), physical complaints (2.0 versus 1.4; P = 0.009), fatigue (2.0 versus 1.6; P = 0.001), and total score (108 versus 90; P < 0.001); abnormal Diabetic Neuropathy Score/Douleur Neuropathique-10 (%): 60.3/13.2 versus 24.5/1.9 (P < 0.001/P = 0.028). Systemic Symptom Checklist (in percent): feeling cold (37.7 versus 17; P = 0.01), weight gain (18.9 versus 1.9; P = 0.008), metallic taste (26.4 versus 3.8; P = 0.002), worsening eyesight (37.7 versus 15.1; P = 0.008) and hearing (24.5 versus 7.5; 0.032), ankle swelling (32.1 versus 7.5; P = 0.002), shortness of breath on exertion (9.4 versus 5.7; P = 0.015), and generalized rash (28.3 versus 7.5; P = 0.01); and Mini-Mental State Examination (median): 29 versus 30 (P = 0.017). Patients in the MoM group were aware of their high cobalt levels and displayed a higher tendency to overreport symptoms (P < 0.001), which could have contributed to the higher scores.
Frequency of reporting a number of symptoms was markedly higher in MoM patients, but clinically significant neurotoxicity was not observed (possibly due to the short exposure to elevated cobalt). Patients with repeated blood Co ≥20 μg/L measurements should be questioned about possible systemic health complaints at follow-up.