成人非创伤性股骨头坏死不同部位骨密度结合骨转换标志物特点研究

Bone mineral density at different sites in adult patients with non-traumatic osteonecrosis of the femoral head combined with bone conversion markers

目的研究成人非创伤性股骨头坏死(ONFH)不同部位的骨密度以及骨转换标志物特点。方法收集2017年9月至2019年3月在广州中医药大学第一附属医院三骨科住院诊断为非创伤性ONFH的患者共150例278髋(坏死组),男92例、女58例,平均年龄为(40.9±9.5)岁,其中酒精性ONFH 43例,特发性ONFH 23例,激素性ONFH 84例,国际骨循环研究会(ARCO)分期Ⅱ期84例,Ⅲ期ARCO 66例。收集同期在广州中医药大学第一附属医院行骨密度检查的健康人群共101例(对照组),男61例、女40例,平均年龄为(41.9±10.7)岁。采用双能X线骨密度测量仪测量2组股骨颈、腰椎(L1~L4)、髋关节的骨密度值,抽血检测2组血清Ⅰ型胶原氨基端延长肽(P1NP)、Ⅰ型胶原降解产物(β-CTx)及碱性磷酸酶(ALP)等骨转换标志物的水平。数据比较采用独立样本t检验与单因素方差分析。结果(1)坏死组的股骨颈骨密度值[(0.97±0.15)g/cm2]高于对照组股骨颈骨密度值[(0.91±0.14)g/cm2],差异有统计学意义(t=3.148,P=0.002),坏死组髋关节骨密度值[(0.94±0.12)g/cm2]、腰椎骨密度值[(1.11±0.14)g/cm2]与对照组髋关节骨密度值[(0.96±0.14)g/cm2]、腰椎骨密度值[(1.12±0.15)g/cm2]相比,差异均无统计学意义(t=-0.548、-1.461,P=0.584、0.145);坏死组患者血清P1NP[(65.44±28.64)ng/mL]、ALP[(68.89±19.15)U/L]水平均高于对照组血清P1NP[(56.82±23.49)ng/mL]、ALP[(59.64±23.72)U/L],而血清β-CTx[(0.54±0.27)ng/mL]水平低于对照组[(0.62±0.29)ng/mL],差异均有统计学意义(t=2.608、3.404、-2.095,P=0.010、0.001、0.037)。(2)坏死组中酒精性ONFH股骨颈骨密度值[(1.02±0.15)g/cm2]高于激素性ONFH[(0.96±0.14)g/cm2]与特发性ONFH[(0.93±0.14)g/cm2],差异有统计学意义(F=3.954,P=0.021);3种坏死类型间腰椎与髋关节的骨密度值、血清P1NP、β-CTx水平比较,差异均无统计学意义(P值均大于0.05),酒精性ONFH血清ALP[(76.09±18.36)U/L]水平高于激素性ONFH[(65.49±18.82)U/L],差异有统计学意义(P<0.05)。(3)坏死组中ARCOⅡ期患者股骨颈骨密度[(0.95±0.15)g/cm2]低于ARCOⅢ期[(1.00±0.14)g/cm2],差异有统计学意义(t=-2.346,P=0.020),腰椎与髋关节骨密度值差异均无统计学意义(P值均大于0.05);ARCOⅡ期患者血清P1NP[(70.24±32.11)ng/mL]、血清β-CTx水平[(0.60±0.27)ng/mL]均高于ARCOⅢ期[(59.33±22.26)ng/mL、(0.47±0.25)ng/mL]患者,差异均有统计学意义(t=2.454、2.985,P=0.015、0.003),两期患者血清ALP水平比较,差异无统计学意义(P>0.05)。结论成人非创伤ONFH的坏死周围区域骨密度可能会升高,且随着病情的进展,坏死部位的修复,坏死周围区域的骨密度呈上升趋势。而在不同坏死类型中,酒精性ONFH周围区域骨密度增高最明显。

Objective To study the characteristics of bone density and bone turnover markers in different parts of adult patients with non-traumatic osteonecrosis of the femoral head(ONFH).Methods A total of 150 patients with non-traumatic ONFH who were admitted to Department of Third Orthopaedics,First Affiliated Hospital of Guangzhou University of Chinese Medicine from September 2017 to March 2019 were diagnosed as non-traumatic ONFH(necrosis group).There were 92 males and 58 females,aged(40.9±9.5)years old.Among them,43 were alcoholic ONFH,23 were idiopathic ONFH and 84 were hormonal ONFH.Association Research Circulation Osseous(ARCO)stageⅡ84 cases,ARCOⅢperiod in 66 cases.During the same period,a total of 101 healthy people(control group)underwent bone mineral density examination in First Affiliated Hospital of Guangzhou University of Chinese Medicine including 61 males and 40 females,aged(41.9±10.7)years old.The bone mineral density values of lumbar spine(L1-L4),femoral neck and hip joint(greater trochanter,intertrochanter line and lesser trochanter)of the two groups were measured by dual-energy X-ray bone density meter.Blood detection of two groups with serum collagen typeⅠamino terminal extension of the peptide(P1NP),collagen typeⅠdegradation products(beta CTx)and alkaline phosphatase(ALP)and so on the levels of bone turnover markers.Independent sample t test and single factor analysis of variance were used for data statistics.Results(1)The femoral neck bone mineral density[(0.97±0.15)g/cm2]in the necrosis group was higher than that in the control group[(0.91±0.14)g/cm2],with statistically significant differences(t=3.148,P=0.002).The hip joint[(0.94±0.12)g/cm2]and lumbar spine bone density[(1.11±0.14)g/cm2]in the necrosis group were compared with the hip joint[(0.96±0.14)g/cm2]and lumbar spine bone density[(1.12±0.15)g/cm2]in the control group.The differences were not statistically significant(t=-0.548,-1.461;P=0.584,0.145).The serum levels of P1NP[(65.44±28.64)ng/mL]and ALP[(68.89±19.15)U/L]in the necrotic group were both higher than those in the control group[(56.82±23.49)ng/mL],[(59.64±23.72)U/L],while the serum levels ofβ-CTx[(0.54±0.27)ng/mL]were lower than those in the control group[(0.62±0.29)ng/mL],the differences were statistically significant(t=2.608,3.404,-2.095;P=0.010,0.001,0.037).(2)In the necrosis group,bone mineral density of femoral neck of alcoholic ONFH[(1.02±0.15)g/cm2]was higher than that of hormone ONFH[(0.96±0.14)g/cm2]and idiopathic ONFH[(0.93±0.14 g/cm2],and the difference was statistically significant(F=3.954,P=0.021).There were no statistically significant differences in bone mineral density,serum P1NP,and serum-ctx levels between the lumbar spine and the hip joint among the three types of necrosis(P>0.05),and serum ALP[(76.09±18.36)U/L]of alcoholic ONFH was higher than that of hormone ONFH[(65.49±18.82)U/L],the difference was statistically significant(P<0.05).(3)The necrosis of ARCOⅡperiod in patients with femoral neck bone mineral density[(0.95±0.15)g/cm2)]below the ARCOⅢperiod[(1.00±0.14)g/cm2],the difference was statistically significant(t=2.346,P=0.020),the lumbar spine and hip bone mineral density values were no statistical difference(P>0.05);ARCOⅡperiod patients serum level of P1NP[(70.24±32.11)ng/mL]andβ-CTx[(0.60±0.27)ng/mL]were higher than ARCOⅢperiod[(59.33±22.26)ng/mL],[(0.47±0.25)ng/mL]patients,and the difference was statistically significant(t=2.454,2.985;P=0.015,0.003),there was no statistical difference in serum ALP level between the two stage patients(P>0.05).Conclusions In adult patients with non-traumatic ONFH,bone mineral density in the area surrounding necrosis may increase,and with the progression of the disease and the repair of the necrotic site,bone mineral density in the area surrounding necrosis tends to increase.Among the different types of necrosis,the increase of bone density in the area around alcoholic ONFH is the most obvious.