摘要
背景:目前缺乏大样本研究对不同病因、分期的股骨头坏死患者的骨代谢水平进行分析,这不利于制定更优的促坏死修复策略。目的:研究不同病因、国际骨微循环研究协会(ARCO)分期股骨头坏死患者的骨代谢水平。方法:回顾性纳入股骨头坏死的患者401例作为试验组,81例健康体检者作为对照组。试验组按照病因不同分为激素性股骨头坏死、酒精性股骨头坏死和创伤性股骨头坏死3组,并按ARCO分期的不同分为Ⅱ期/Ⅲ期/Ⅳ期。收集所有受试者的7项骨代谢相关指标,包括骨代谢调控激素25-羟基维生素D,骨转换标志物Ⅰ型前胶原N末端前肽、β-胶原降解产物、骨钙素N端中分子片段,骨代谢一般生化标记血清Ca、P、碱性磷酸酶。比较各组受试者的骨代谢水平,并应用二元Logistic回归分析与股骨头坏死发病相关的独立因素。结果与结论:①与对照组比较,试验组患者的β-胶原降解产物、Ⅰ型前胶原N末端前肽、骨钙素N端中分子片段、血清P、碱性磷酸酶水平均显著升高(均P<0.05);②以是否发病为结局,应用二元Logistic回归分析得出β-胶原降解产物、Ⅰ型前胶原N末端前肽、骨钙素N端中分子片段是与股骨头坏死发病相关的独立因素;③不同病因3组患者的β-胶原降解产物、Ⅰ型前胶原N末端前肽水平均高于正常参考值;酒精性股骨头坏死组患者的25-羟基维生素D、血清Ca水平均高于其他2组(P<0.05);激素性股骨头坏死、创伤性股骨头坏死组患者的25-羟基维生素D水平均低于正常值;④ARCOⅡ、Ⅲ、Ⅳ期股骨头坏死患者的7项骨代谢指标水平比较差异均无显著性意义(均P>0.05),但3组患者的β-胶原降解产物、Ⅰ型前胶原N末端前肽均高于正常参考值;ARCOⅡ期、Ⅳ期患者的25-羟基维生素D低于正常参考值;⑤结论:股骨头坏死患者的骨代谢水平异常,不同病因、ARCO分期的股骨头坏死患者的β-胶原降解产物、Ⅰ型前胶原N末端前肽均高于正常参考值,处于高骨转换状态;β-胶原降解产物、Ⅰ型前胶原N末端前肽、骨钙素N端中分子片段可能是股骨头坏死发病的危险因素。
BACKGROUND:Currently,there is a lack of large sample studies to analyze the bone metabolism level of patients with femoral head necrosis of different etiologies and stages,which is not conducive to the development of better necrosis-promoting repair strategies.OBJECTIVE:To study the bone metabolism of patients with osteonecrosis of the femoral head with different etiologies and Association Research Circulation Osseous(ARCO)stages.METHODS:A retrospective study was performed on 401 patients diagnosed with osteonecrosis of the femoral head as the trial group,and 81 healthy subjects as the control group.The trial group could be divided into three groups according to different etiologies:steroid-induced osteonecrosis of the femoral head,alcoholic osteonecrosis of the femoral head and traumatic osteonecrosis of the femoral head,and were divided into stages II/III/IV according to different ARCO stages.Seven bone metabolism-related indicators of all subjects were collected,including bone metabolism-regulating hormone 25-hydroxyvitamin D and bone conversion markers:N-terminal propeptide of type I procollagen,degradation product of type I collagen,n-terminal middle molecular fragment of osteocalcin,general biochemical markers of bone metabolism:serum calcium,serum phosphorus,serum alkaline phosphatase.The bone metabolism levels of each group were compared and the independent factors associated with osteonecrosis of the femoral head were determined by binary Logistic regression analysis.RESULTS AND CONCLUSION:Compared with the control group,levels of degradation product of type I collagen,N-terminal propeptide of type I procollagen,n-terminal middle molecular fragment of osteocalcin,serum phosphorus and alkaline phosphatase in the trial group were significantly increased(all P<0.05).Based on the presence or absence of the disease,according to binary Logistic regression analysis,degradation product of type I collagen,N-terminal propeptide of type I procollagen,and n-terminal middle molecular fragment of osteocalcin were independent factors associated with osteonecrosis of the femoral head.The levels of degradation product of type I collagen and N-terminal propeptide of type I procollagen in three groups of patients with different etiologies were higher than normal reference values.The bone metabolism-regulating hormone 25-hydroxyvitamin D and serum calcium in the alcoholic osteonecrosis of the femoral head group were higher than those in the other two groups(P<0.05).The level of bone metabolism-regulating hormone 25-hydroxyvitamin D in steroid-induced and traumatic osteonecrosis of the femoral head groups was lower than the normal value.There were no significant differences in seven bone metabolism-related indicators in patients with ARCO stages II,III and IV osteonecrosis of the femoral head(all P>0.05),but degradation product of type I collagen and N-terminal propeptide of type I procollagen in these three groups were higher than normal reference values.Bone metabolism-regulating hormone 25-hydroxyvitamin D in patients with ARCO stage II and ARCO stage IV was lower than the normal reference value.It is concluded that the bone metabolism level of osteonecrosis of the femoral head patients was abnormal.The degradation product of type I collagen and N-terminal propeptide of type I procollagen of osteonecrosis of the femoral head patients with different etiologies and ARCO stages were all higher than the normal reference value,and they were in a state of high bone turnover.Degradation product of type I collagen,N-terminal propeptide of type I procollagen and n-terminal middle molecular fragment of osteocalcin may be risk factors for the pathogenesis of osteonecrosis of the femoral head.
作者
陈立刚
何晓铭
谭昱
肖育志
马春涛
郭良
Chen Ligang;He Xiaoming;Tan Yu;Xiao Yuzhi;Ma Chuntao;Guo Liang(Sanya Traditional Chinese Medicine Hospital,Sanya 572000,Hainan Province,China;Third Affiliated Hospital of Guangzhou University of Chinese Medicine(Guangdong Academy of Traditional Chinese Medicine),Hip Research Center of Guangzhou University of Chinese Medicine,Guangzhou 510000,Guangdong)
出处
《中国组织工程研究》
CAS
北大核心
2024年第16期2461-2466,共6页
Chinese Journal of Tissue Engineering Research
关键词
股骨头坏死
骨代谢
病因
ARCO分期
Ⅰ型前胶原N末端前肽
osteonecrosis of the femoral head
bone metabolism
etiology
ARCO stage
N-terminal propeptide of type I procollagen
