非创伤性股骨头坏死患者血清OPG、RANK及RANKL的水平变化及临床意义

Changes and Clinical Significance of Serum OPG、RANK and RANKL Levels in Patients With Non⁃traumatic Osteonecrosis of the Femoral Head

目的观察非创伤性股骨头坏死(NONFH)患者血清中OPG、RANK及RANKL的水平变化并探讨其临床意义。方法选取2019年1~6月郑州中医骨伤病医院收治的85例股骨头坏死患者设为NONFH组,55例同期体检者设为对照组。两组人员均在晨间进食前采集肘静脉血3 mL,离心后保留血清,采用双抗体夹心酶联免疫吸附实验(ELISA)检测两组人群血清中OPG、RANK和RANKL水平。同时分析不同性别、病因、发病侧别、ARCO分期和年龄段对NONFH患者血清OPG、RANK和RANKL水平的影响。结果与对照组相比,NONFH组患者血清中OPG水平显著降低(P=0.000),RANK和RANKL水平显著升高(P=0.000,P=0.001),OPG/RANKL比值显著降低(P=0.000)。不同病因(激素性、酒精性和特发性)所致的股骨头坏死患者血清中OPG、RANK和RANKL水平均无统计学意义(P=0.170,P=0.730,P=0.084)。不同发病侧别、不同ARCO分期、不同性别和不同年龄段NONFH患者血清OPG、RANK和RANKL水平无统计学意义(均P>0.05)。结论NONFH患者血清OPG水平显著低于健康人群水平,而RANK和RANKL水平显著高于健康人群水平,提示OPG/RANK/RANKL系统参与非创伤性股骨头坏死病理发生和发展。这说明了NONFH骨代谢异常,激素、酒精和原发性因素导致骨丢失,与OPG、RANK水平和OPG/RANKL比值密切相关,但是OPG、RANK和RANKL水平与病因、侧别、ARCO分期、性别和年龄无关。

OBJECTIVE To explore the changes and significance of serum osteoprotegerin(OPG),receptor activator of nuclear factor⁃κB(RANK)and receptor activator for nuclear factor⁃κB ligand(RANKL)levels in patients with non⁃traumatic osteonecrosis of the femoral head(NONFH).METHODS 85 patients with NONFH who received treatment in a hospital from January to June 2019 were selected as the observation group(NONFH group)and 55 healthy adults who received physical examination at the same period were selected as the control group.The albow venous blood was collected at fasting in the morning,and the serum was separated.The levels of OPG,RANK and RANKL in the serum were detected by double antibody sandwich enzyme⁃linked immunosorbent assay(ELISA).At the same time,the effects of different gender,causes,onset side,ARCO stage and age on serum OPG,RANK and RANKL levels in NONFH patients were analyzed.RESULTS Compared with the control group,the OPG level in the serum of patients in the NONFH group was significantly reduced(P=0.000),the levels of RANK and RANKL were significantly increased(P=0.000,P=0.001),and the OPG/RANKL ratio was significantly reduced(P=0.000).The OPG,RANK and RANKL levels in serum of patients with femoral head necrosis caused by different etiologies(hormonal,alcoholic,and idiopathic)were not statistically significant(P=0.170,P=0.730,P=0.084).The serum OPG,RANK and RANKL levels of NONFH patients with different incidence sides,different ARCO stages,different genders and different ages were not statistically significant(all P>0.05).CONCLUSION The serum level of OPG in patients with NONFH is significantly lower than that in healthy people,while the serum levels of RANK and RANKL are significantly higher than that in healthy people,suggesting that OPG/RANK/RANKL system is involved in the pathogenesis and development of NONFH.This shows that non⁃traumatic ONFH bone metabolism abnormalities,hormones,alcohol and primary factors cause bone loss,which is closely related to OPG,RANK levels and the ratio of OPG/RANKL,while the levels of OPG,RANK and RANKL are not related to causes,sides,ARCO stages,genders,and ages.