股骨头和血清LncRNA HOTAIR表达与非创伤性股骨头坏死进展的相关性

目的探讨非创伤性股骨头坏死（ONFH）患者血清和股骨头局部LncRNA HOX转录反义RNA（HOTAIR）的表达与疾病严重程度的关系。方法纳入本院接收的保髋或全髋置换的非创伤性ONFH患者90例，健康对照84例。RT-PCR检测血清和局部HOTAIR的表达，影像学进展由国际骨循环研究学会（ARCO）分期判定，采用VAS和Harris髋关节评分评价ONFH患者临床严重程度，应用ROC曲线确定血清HOTAIR在影像学进展中的诊断价值。结果非创伤性ONFH患者血清HOTAIR表达高于健康对照组(1.97±0.32 vs 1.00±0.10，P < 0.001)，ONFH组织中的局部HOTAIR在坏死区高于非坏死区(2.37±0.25 vs 1.00±0.10，P < 0.001)。ARCO 4级的ONFH患者血清和局部HOTAIR表达高于3级（2.22±0.28 vs 1.94±0.36，P=0.001；2.58±0.22 vs 2.42±0.32，P=0.02）。ARCO 3级的ONFH患者与ARCO 1/2级相比，血清HOTAIR表达升高（1.94±0.36 vs 1.73±0.23，P=0.009；2.42±0.32 vs 2.13±0.24，P < 0.001）。血清中和局部HOTAIR的表达与ARCO分级呈显著正相关（r=0.569，P < 0.001；r=0.585，P < 0.001）。血清和局部HOTAIR表达与VAS评分呈正相关（血清r=0.557，P < 0.001；局部r=0.672，P < 0.001），与HSS评分呈显著负相关（血清r=-0.326，P=0.002；局部r=-0.489，P < 0.001）。ROC曲线分析显示，血清HOTAIR可作为诊断非创伤性ONFH影像学进展的良好指标(AUC=0.663, P=0.030; AUC=0.726, P=0.003)。结论非创伤性ONFH患者血清和局部HOTAIR表达升高可能反映ONFH病情的严重程度。 

Correlation of local and serum LncRNA HOTAIR expressions with disease severity of non-traumatic ONFH

ObjectiveTo investigate the relationship between the serum and local expressions of LncRNA HOTAIR and the disease severity in patients with non- traumatic ONFH.MethodsNinety non- traumatic ONFH patients and 84 healthy controls were enrolled. RT-PCR was used to detect the expression of serum and local HOTAIR. The radiographic progression was determined by ARCO stage. The clinical severity of ONFH was evaluated by VAS and Harris hip score. ROC curve was used to determine the diagnostic value of serum HOTAIR with regard to radiographic progression.Resultsthe expression of serum HOTAIR in patients with non-traunatic ONFH was significantly higher than that in healthy controls (1.97±0.32 vs 1.00± 0.10, P < 0.001), and the local HOTAIR expression in the necrotic area was significantly higher compared with the non-necrotic area (2.37±0.25 vs 1.00±0.10, P < 0.001). The expressions of serum and local HOTAIR in ARCO 4 were significantly higher than ARCO 3(2.22±0.28 vs 1.94±0.36, P=0.001;2.58±0.22 vs 2.42±0.32, P=0.020), and the expression of serum and local HOTAIR in ARCO 3 was significantly higher than ARCO 1/2(1.94±0.36 vs 1.73±0.23, P=0.009;2.42±0.32 vs 2.13±0.24, P < 0.001). Expressions of HOTAIR in serum and local area were positively associated with ARCO grade(r=0.569, P < 0.001; r=0.585, P < 0.001), VAS score (r=0.557, P < 0.001; r=0.672, P < 0.001)and negatively related to Harris hip score(r=-0.326, P=0.002; r=-0.489, P < 0.001). Further ROC curve analysis showed that serum HOTAIR could be used as a decent indicator for the radiograohic progression of nontraumatic ONFH (AUC=0.663, P=0.030; AUC=0.726, P=0.003).ConclusionThe increase of serum and local HOTAIR expression in patients with non-traumatic ONFH may reflect the severity of the disease.