OPG、RANK、RANKL及血液学指标水平变化与股骨头坏死的相关性研究

Study on the correlation between the changes of OPG,RANK,RANKL and hematological indexes and osteonecrosis of the femoral head

目的探讨骨保护素(OPG)、核因子κB受体活化因子(RANK)、核因子κB受体活化因子配体(RANKL)及血液学指标与股骨头坏死(ONFH)的关系,为临床疗效评价提供依据。方法选取2019年7-12月郑州中医骨伤病医院收治的ONFH患者84例作为ONFH组,按不同年龄分为青年组(18~<40岁,32例)、中年组(40~<60岁,47例)和老年组(≥60岁,5例),按不同病因分为激素组(14例)、酒精组(44例)、特发组(21例)和创伤组(5例),按不同中医证型分为肝肾亏虚组(36例),湿热蕴结组(48例)。选取同期健康体检者81例作为对照组。采集ONFH组和对照组研究对象清晨空腹肘静脉血进行酶联免疫吸附测定和血液检查。分析OPG、RANK、RANKL及血液学指标与ONFH、中医证型的相关性。结果与对照组比较,ONFH组患者OPG水平明显降低,RANK、RANKL水平,RANKL/OPG比值,以及总胆固醇、三酰甘油、低密度脂蛋白(LDL)、载脂蛋白B(ApoB)水平均明显升高,载脂蛋白A、高密度脂蛋白水平均明显降低,差异均有统计学意义(P<0.05)。ONFH组的中年组患者RANKL/OPG比值明显高于老年组,青年粗、中年组患者LDL、ApoB,活化部分凝血活酶时间(APTT)均明显低于老年组,差异均有统计学意义(P<0.05)。ONFH组中酒精组患者RANK、RANKL、OPG水平明显高于创伤组,RANK水平明显高于激素组,激素组、酒精组和特发组患者APTT、PT、PIB、TT均明显高于创伤组,差异均有统计学意义(P<0.05)。湿热蕴结组患者RANKL水平明显高于肝肾亏虚组,差异有统计学意义(P<0.05)。肝肾亏虚证组患者血液学指标比较,差异均无统计学意义(P>0.05)。结论OPG、RANKL、RANK和凝血机制在ONFH患者中受激素和酒精的影响,不受肝肾亏虚证和湿热蕴结证型的影响。

Objective To explore the relationship between osteoprotegerin(OPG),receptor activator of NF-κB(RANK),receptor activator of NF-κB ligand(RANKL),hematological indexes and osteonecrosis of the femoral head(ONFH),so as to provide basis for clinical efficacy evaluation.Methods A total of 84 patients with ONFH treated in Zhengzhou Traditional Chinese Hospital of Orthopedics from July to December 2019 were selected as the ONFH group.The patients were divided into the young group(18-<40 year,n=32),middle-aged group(40~<60 year,n=47)and old group(≥60 year,n=5)according to their ages.According to different causes,the patients were divided into the hormone group(n=14),alcohol group(n=44),idiopathic group(n=21)and trauma group(n=5).According to different traditional Chinese medicine syndrome types,the patients were divided into the liver and kidney deficiency group(n=36)and damp-heat accumulation group(n=48).A total of 81 healthy subjects in the same period were selected as the control group.The early morning fasting elbow venous blood of the ONFH group and control group was collected for the enzyme-linked immunosorbent assay(ELISA)and blood examination.The correlation between OPG,RANK,RANKL,hematological indexes and ONFH,traditional Chinese medicine syndrome types was analyzed.Results Compared with those of the control group,the level of OPG in the ONFH group was significantly lower,while the RANK level,RANKL level and RANKL/OPG ratio of the ONFH group were significantly higher,and the levels of the total cholesterol,triglyceride,low density lipoprotein(LDL)and apolipoprotein B(ApoB)significantly increased,while the apolipoprotein A and high-density lipoprotein significantly decreased.The differences were statistically significant(P<0.05).The RANKL/OPG ratio in the middle-aged group of the ONFH group was significantly higher than that in the older group,and the LDL,ApoB and activated partial thromboplastin time(APTT)in the young and middle-aged groups were significantly lower than those in the older group,and the differences were statistically significant(P<0.05).Patients in the alcohol group of the ONFH group had significantly higher RANK,RANKL,and OPG levels than those in the trauma group,and significantly higher RANK levels than those in the hormone group,the APTT,prothrombin time(PT),fibrinogen(FIB)and thrombin time(TT)of patients in the hormone group the alcohol group and the special hair group were significantly higher than in the trauma group,and the differences were all statistically significant(P<0.05).The RANKL levels of patients in the Damp-Heat group were significantly higher than those in the Liver and kidney deficiency syndrome,with statistically significant differences(P<0.05).The differences were not statistically significant when comparing the hematological indexes of patients in the liver and kidney deficiency syndrome(P>0.05)rothrombin timeibrinogenthrombin time.Conclusion OPG,RANKL,RANK and blood coagulation mechanisms were affected by hormone and alcohol in the ONFH patients,but not by liver and kidney deficiency syndrome and damp-heat accumulation syndrome.