血清同型半胱氨酸、叶酸及维生素B12水平在非创伤性股骨头坏死疾病进展中的临床价值

Clinical value of serum homocysteine,folate,and vitamin B12 levels in the progression of non-traumatic osteonecrosis of the femoral head

目的:同型半胱氨酸(homocysteine,Hcy)与非创伤性股骨头坏死(non-traumatic osteonecrosis of the femoral head,NONFH)发病机制密切相关,然而叶酸和维生素B12(vitamin B12,B12)作为Hcy代谢的重要辅助因子,与NONFH之间的关系尚不清楚。本研究旨在探讨血清Hcy、叶酸及B12水平在NONFH疾病进展中的临床价值。方法:选取2019年4月至2022年3月大连大学附属中山医院收治的83例NONFH患者(NONFH组)和58例健康体检者(对照组)作为研究对象,检测2组血清中Hcy、叶酸及B12水平,分析评估各项指标之间及其与国际骨循环研究会(International Society for Researchon the Bone Circulation,ARCO)分期的相关性。采用受试者操作特征(receiver operator characteristic,ROC)曲线评估各项指标对股骨头塌陷的预测价值。结果:与对照组相比,NONFH组血清Hcy水平显著升高,叶酸和B12水平显著降低,差异均有统计学意义(均P<0.05)。Spearman相关性分析表明:血清Hcy水平与NONFH患者ARCO分期呈正相关(r=0.532,P<0.05),血清叶酸、B12水平与ARCO分期呈负相关(r=-0.432、r=-0.483,均P<0.05)。ROC曲线结果表明:Hcy、叶酸和B12及三者联合检测的曲线下面积(area under the curve,AUC)对NONFH股骨头塌陷的预测价值分别为0.800、0.731、0.741、0.869。结论:血清Hcy、叶酸及B12水平与NONFH患者疾病进展之间有相关性,三者联合检测对NONFH股骨头塌陷的预测价值较高。

Objective:Homocysteine(Hcy)is closely related to the pathogenesis of non-traumatic osteonecrosis of the femoral head(NONFH).However,the relationship between NONFH and important cofactors in Hcy metabolism,folate and vitamin B12(B12),is not yet clear.This study aims to investigate the clinical value of serum levels of Hcy,folate,and B12 in the progression of NONFH.Methods:A total of 83 NONFH patients(NONFH group)and 58 healthy individuals undergoing health examinations(control group)admitted to the Affiliated Zhongshan Hospital of Dalian University,from April 2019 to March 2022 were selected as the study subjects.Serum levels of Hcy,folate,and B12 were measured in both groups.The correlation between these indicators and the staging according to the International Society for Research on the Bone Circulation(ARCO)was analyzed.Receiver operator characteristic(ROC)curves were used to assess the predictive value of these indicators for femoral head collapse.Results:Compared to the control group,the NONFH group showed significantly elevated serum Hcy levels and significantly decreased folate and B12 levels(all P<0.05).Spearman correlation analysis showed a positive correlation between serum Hcy levels and ARCO staging in NONFH patients(r=0.532,P<0.05),while serum folate and B12 levels showed a negative correlation with ARCO staging(r=−0.432,r=−0.483,P<0.05).ROC curve showed that the area under the curve(AUC)for the predictive value of Hcy,folate,B12,and their combined detection for femoral head collapse in NONFH were 0.800,0.731,0.741,and 0.869,respectively.Conclusion:Serum levels of Hcy,folate,and B12 are significantly correlated with the progression of NONFH,and their combined detection has a higher predictive value for femoral head collapse in NONFH..