不同中医证型骨质疏松性髋部骨折患者ERK1/2通路表达

目的 探讨不同中医证型骨质疏松性髋部骨折患者胞外信号调节激酶（ERK1/2）信号通路的表达变化。方法 前瞻性选取华中科技大学同济医学院附属梨园医院和湖北省中医院2018年11月-2021年12月收治的120例因骨质疏松性髋部骨折、行全髋关节置换术患者。根据骨质疏松症中医辨证分型标准，分为肝肾阴虚证、脾肾阳虚证、肾阳虚衰证、气滞血瘀证4个证型，所有患者均检测组织ERK1/2 mRNA和ERK1/2 蛋白表达水平，分析不同证型患者ERK1/2表达差异。结果 120例患者的中医证型中肝肾阴虚型占比较高，其次为脾肾阳虚型、肾阳虚型，血瘀气滞型占比最低，男性多为肾阳虚型，女性多为肾阴虚型，气滞血型患者平均年龄髙于其他证型（P＜0.05）；不同中医证型患者的L2~4、股骨颈、转子区、Wards区骨密度值比较，血瘀气滞型＜肾阳虚型、脾肾阳虚型＜肝肾阴虚型（P＜0.05）；不同中医证型患者的ERK1/2 mRNA、ERK1/2蛋白表达水平比较，血瘀气滞型＜肾阳虚型、脾肾阳虚型＜肝肾阴虚型（P＜0.05）；Pearson相关性分析结果显示，受试者的L2~4、股骨颈、转子区、Wards区骨密度平均值与ERK1 mRNA、ERK2 mRNA、ERK1蛋白、ERK2 蛋白表达水平呈正相关（r=0.251、0.306、0.318、0.270，P均＜0.05）。结论 血瘀气滞型骨质疏松症患者的ERK1/2 mRNA和蛋白表达水平低于肾阳虚者，肾阳虚者低于肾阴虚者，且表达水平与患者骨密度呈正相关。

Expressions of ERK1/2 pathways in patients with osteoporotic hip fractures of different TCM syndromes

Objective To explore the changes of extracellular signal-regulated kinase (ERK1/2) signaling pathways in patients with osteoporotic hip fractures of different TCM syndromes. Methods A total of 120 patients with osteoporotic hip fractures undergoing total hip arthroplasty in the Liyuan Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology and Hubei Provincial Hospital of Traditional Chinese Medicine were prospectively enrolled between November 2018 and December 2021. According to different TCM syndromes, there were liver-kidney yin deficiency syndrome, spleen-kidney yang deficiency syndrome, kidney-yang deficiency syndrome and qi-stagnation blood stasis syndrome. The expression levels of ERK1/2 mRNA and proteins were detected. The differences of ERK1/2 in patients with different syndromes were analyzed. Results Among the 120 patients, proportion of liver-kidney yin deficiency syndrome was the highest, followed by spleen-kidney yang deficiency syndrome, kidney-yang deficiency syndrome and qi-stagnation blood stasis syndrome. The kidney-yang deficiency syndrome was common in males, and kidney-yin deficiency was common in females. The average age of patients with qi-stagnation blood syndrome was higher than that with other syndromes (P<0.05). The bone mineral density values of L2-4, femoral neck, trochanter area and Wards area were the greatest in patients with liver-kidney yin deficiency syndrome, followed by spleen-kidney yang deficiency syndrome, kidney-yang deficiency syndrome and qi-stagnation blood stasis syndrome (P<0.05). The expression level of ERK1/2 mRNA was the highest in patients with liver-kidney yin deficiency syndrome, followed by spleen-kidney yang deficiency syndrome, kidney-yang deficiency syndrome and qi-stagnation blood stasis syndrome (P<0.05), and expression levels of ERK1/2 proteins were the same (P<0.05). The results of Pearson correlation analysis showed that mean BMD values of L2-4, femoral neck, trochanter area and Wards area were positively correlated with expression levels of ERK1 mRNA, ERK2 mRNA, ERK1 protein and ERK2 protein (r=0.251, 0.306, 0.318, 0.270, P<0.05). Conclusion The expression levels of ERK1/2 mRNA and proteins are the highest in patients with osteoporosis of kidney yin deficiency syndrome, followed by kidney yang deficiency syndrome and qi-stagnation blood stasis syndrome. And their expression levels are positively correlated with BMD.