晚期糖基化终末产物与股骨头坏死进展的相关性研究

背景　股骨头坏死（ONFH）是骨科临床难治性疾病，由于诊断不及时，塌陷进程快，很多患者不可避免地要面临人工全髋关节置换术的结局，寻找科学诊断早期ONFH的方法具有非常重要的现实意义。目的　分析国际骨循环学会分期（ARCO）Ⅱ~Ⅳ期ONFH患者的血浆晚期糖基化终末产物（AGEs）水平，研究其与ONFH发展进程的相关性。方法　2016年6-12月随机选取广州中医药大学第一附属医院三骨科住院治疗的ONFH患者为试验组，广州中医药大学第一附属医院体检中心进行体检的健康成年人为对照组，收集试验组患者的影像资料，按ARCO标准分为ARCO Ⅱ期、ARCO Ⅲ期、ARCO Ⅳ期。使用酶联免疫吸附测定（ELISA）检测所有研究对象的AGEs水平，分析两组间、试验组内不同坏死原因、不同ARCO分期及塌陷前后患者的AGEs水平。结果　试验组AGEs水平〔（2.87±0.73）mg/L〕高于对照组〔（2.33±0.94）mg/L〕（t=3.692，P<0.001）。不同ARCO分期、塌陷前后、病因ONFH患者AGEs水平比较，差异均有统计学意义（P<0.05）；其中ARCO分期Ⅱ期AGEs水平低于Ⅳ期，创伤性（T）病因患者AGEs水平高于酒精性（AI）、激素性（SI）、特发性（ID）（P<0.05）。Spearman相关性分析结果显示，AGEs水平与ARCO分期呈正相关（rs=0.274，P=0.007）。ROC曲线下面积为0.651（0.567，0.729），AGEs水平切点为2.419 mg/L时，灵敏度为72.45%，特异度为59.09%。结论　AGEs与ONFH的进展过程密切相关，对于诊断ONFH及病情监测具有一定参考价值。

Correlation between Advanced Glycation End Products and Progression of Osteonecrosis of the Femoral Head

Background　Osteonecrosis of femoral head（ONFH） is a refractory orthopedic disease.Due to delayed early diagnosis and rapid collapse process，many patients may inevitably undergo total hip arthroplasty.Therefore，it is of great practical significance to find a scientific method to diagnose ONFH.Objective　To analyze the plasma advanced glycation end products（AGEs） in patients with ONFH（ARCOⅡ-Ⅳ） and to study its correlation with the development of ONFH.Methods　ONFH inpatients（consisting of ARCO Ⅱ，Ⅲand Ⅳ based on imaging data） and healthy adult physical examinees were recruited from No.3 Orthopaedic Department，and Physical examination Center，the First Affiliated Hospital of Guangzhou University of Chinese Medicine，respectively，during June to December 2016.ELISA-detected plasma AGEs were compared between ONFH inpatients and healthy controls，and were compared in ONFH inpatients by causes of ONFH，ARCO stage，pre- and post-collapse stages.Results　The mean plasma AGEs concentration in ONFH inpatients〔（2.87±0.73）mg/L〕 was greater than that of the healthy controls〔（2.33±0.94）mg/L〕（t=3.692，P<0.001）.The AGEs concentration varied significantly among ARCOⅡ，Ⅲand Ⅳ patients（P<0.05）.Those with ARCOⅡshowed lower mean AGEs concentration than those with ARCOⅣ（P<0.05）.The AGEs concentration also varied significantly among the patients either at pre-collapse or post-collapse stage of ONFH（P<0.05）.Furthermore，the AGEs concentration changed significantly according to the causes of ONFH（P<0.05）.In particular，patients with trauma-induced ONFH had higher mean AGEs concentration than those with alcohol-induced，steroid-induced or idiopathic ONFH（P<0.05）.According to the results of Spearman correlation analysis，AGEs concentration was positively correlated with ARCO stage（rs=0.274，P=0.007）.ROC curve analysis showed that the AUC of AGEs in idnetifying the collapse of ONFH was 0.651（0.567，0.729），with 72.45% sensitivity and 59.09% specificity when the cut-off value was determined as 2.419 mg/L.Conclusion　Plasma AGEs concentration is closely related to the progress of ONFH，which may be used as a reference for diagnosis of ONFH and disease monitoring.