非创伤性股骨头坏死患者血清颗粒蛋白前体表达及临床意义

Clinical significance of serum expression of progranulin in non-traumatic osteonecrosis of femoral head

目的探讨血清颗粒蛋白前体(PGRN)测定对非创伤性股骨头坏死(NONFH)的临床诊断价值。方法选取75例NONFH患者为NONFH组,性别和年龄匹配的健康个体67例为健康组。酶联免疫吸附试验检测血清PGRN水平。采用疼痛视觉模拟评分(VAS)和Harris评分评价髋关节疼痛及功能情况,比较不同临床特征NONFH患者的血清PGRN水平;对PGRN与临床指标进行相关性分析;采用受试者工作特征(ROC)曲线分析血清PGRN水平对NONFH的诊断价值。结果NONFH组血清PGRN水平高于健康组(P<0.05)。不同病因NONFH患者组间PGRN水平比较差异无统计学意义;双侧坏死的NONFH患者PGRN水平显著高于单侧坏死患者,股骨头塌陷NONFH患者PGRN水平显著高于未塌陷患者(P<0.05);血清PGRN水平与股骨头坏死国际骨循坏协会(ARCO)分期(r_(s)=0.645)、疼痛VAS评分呈正相关(r=0.694),与Harris评分呈负相关(r=-0.732,均P<0.01)。ROC曲线结果显示PGRN用于诊断NONFH的曲线下面积为0.786(95%CI:0.710~0.862,P<0.01),最佳临界值为14.55μg/L,敏感度为0.640,特异度为0.910。结论血清PGRN水平可反映NONFH的病情严重程度,对NONFH的诊断存在一定价值。

Objective To explore the clinical value of serum progranulin(PGRN) in non-traumatic osteonecrosis of femoral head(NONFH).Methods A total of 75 patients with NONFH were selected as the NONFH group,and 67 healthy individuals matched for sex and age were selected as the healthy group.Serum PGRN concentration was detected by enzymelinked immunosorbent assay.The visual analogue scale(VAS) and Harris score were used to evaluate the hip joint pain and function.The general data and imaging results were compared between the two groups.The serum PGRN levels of NONFH patients with different clinical characteristics were compared.The correlation between PGRN and clinical indicators was analyzed.Receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of serum PGRN level in NONFH.Results The level of serum PGRN was significantly higher in the NONFH group than that in the healthy group(P <0.05).There was no significant difference in PGRN levels between NONFH patients with different etiologies.The level of PGRN was significantly higher in NONFH patients with bilateral necrosis than that in patients with unilateral necrosis,and the level of PGRN was significantly higher in NONFH patients with femoral head collapse than that in patients without collapse(P <0.05).The level of serum PGRN was positively correlated with ARCO stage(r_(s)=0.645) and VAS score of pain(r=0.694),but negatively correlated with Harris score(r=-0.732,P <0.01).ROC curve results showed that the area under the curve of PGRN for the diagnosis of NONFH was 0.786(95%CI:0.710-0.862,P <0.01),the optimal cut-off value was 14.55 μg/L,the sensitivity was 0.640 and the specificity was 0.910.Conclusion Serum PGRN level can reflect the severity of NONFH and has certain value in the diagnosis of NONFH.