股骨头坏死关节液Ⅱ型胶原羧基端端肽检测及临床意义

Measurement and clinical significance of C-telopeptide of type Ⅱ collagen in synovial fluid of osteonecrosis of femoral head

目的：探讨髋关节液中Ⅱ型胶原羧基端端肽（ CTX-Ⅱ）含量与股骨头坏死软骨病变的关系。方法选择38例（43髋）股骨头坏死和6例（4髋、2膝）阴性对照患者，应用双抗体夹心酶标免疫法测定关节液中CTX-Ⅱ含量，比较各组间的差异及相关性。结果股骨头坏死各组关节液中CTX-Ⅱ的含量明显高于阴性组，ⅢA组与阴性组比较（ P＝0.109），ⅢB组、ⅢC组分别与阴性组比较（P＜0.01），三组间两两比较（P＜0.05）；＜6月组与阴性组比较（P＞0.05），6～11月组、≥12月组CTX-Ⅱ含量高于阴性组（P＜0.01），＜6月组CTX-Ⅱ含量低于6～11月组及≥12月组（P＜0.05），而6～11月组与≥12月组比较（ P＞0.05）；病因分组比较无差异（ P＞0.05）；股骨头坏死髋关节液中CTX-Ⅱ含量与塌陷程度、疼痛时间、病因等因素的Spearman秩相关系数分别为0.943、0.595（ P＜0.01），0.112（P＞0.05）。结论股骨头坏死关节液CTX-Ⅱ含量可作为生物标记物反映关节软骨病变程度，为临床制定合理治疗方案提供依据。

Objective To explore the relationship between the level of C-telopeptide of type Ⅱ collagen （CTX-Ⅱ ） in the synovial fluid and the cartilage lesion of osteonecrosis of the femoral head （ONFH）. Methods The synovial fluid liquid （2 -5 ml） of 38 ONFH patients （43 hips） and six （four hips, two knees ） negative patients were extracted in the operation. The CTX-Ⅱ in the synovial fluid was measured by the double antibody sandwich enzyme-linked immunosorbent assay. The differences and correlation were compared between the groups. Results The CTX-Ⅱ of the ONFH groups was significantly higher than that of the negative group. There was no significant difference （P 〉 0. 05 ） between the stage m A group and the negative group. The differences among the stage m B group, the stage Ⅲ C group and the negative group were statistically significant by paired comparison （ P 〈 0. 01 ）. There was statistically significant difference （ P 〈0. 05 ） between any two groups of stage Ⅲ. There was no significant difference （P 〉0. 05） between the less-than-six-month group and the negative group. The CTX- 1I results in the 6 - 11 months group and the over-12-month group were higher than the negative group, and the difference was statistically significant （P 〈 0. 01 ）. The patients in the less-than-six-month group had lower CTX-Ⅱ level than the patients in the 6 - 11 months group and the over-12-month group; the differences were statistically significant （ P 〈 0. 05 ）. There was no significant difference （ P 〉 0.05 ） between the 6 - 11 months group and the over-12-month group. As for the etiology groups, there was no statistically significant difference （ P 〉 0. 05 ）. The spearman rank correlation coefficients of the CTX- Ⅱ level in the ONFH joint fluid with collapse extent, pain duration and etiology were 0.943, 0.595 （P 〈 0.01）, 0.112 （P 〉 0.05）, respectively. Conclusion CTX-Ⅱ in the ONFH joint fluid can be used as a biomarker reflected the degree of articular cartilage lesion, and the assessment can provide a guidance for the treatment of ONFH.