非创伤性股骨头坏死血清视黄醇结合蛋白-4的意义△

Significance of serum retinol binding protein-4 in non-traumatic osteonecrosis of femoral head

摘要:

[目的] 探讨视黄醇结合蛋白-4 (retinol binding protein-4, RBP4) 在非创伤性股骨头坏死 (nontraumatic necrosis of femoral head, NONFH)中的诊断价值。[方法]选取 2021 年 8 月—2021 年 12 月在临沂市人民医院就诊的 NONFH 患者 70 例作为坏死组，选取同期年龄、性别与坏死组相匹配的 62 例健康体检者作为正常人组，采用酶联免疫吸附法检测两组受试者血清 RBP4 浓度水平。比较两组间一般资料，坏死组按不同因素 (病因、ARCO 分期等) 比较血清 RBP4 浓度水平，并绘制检测 ROC 曲线，分析血清 RBP4 对 NONFH 的诊断价值。[结果]坏死组血清 RBP4 水平显著低于正常人组(P＜0.05)。坏死组中，股骨头塌陷患者血清 RBP4 水平显著低于未塌陷患者 (P＜0.05)，双侧坏死患者的 RBP4 水平显著低于单侧坏死 (P＜0.05)；不同 ARCO 分期的患者血清 RBP4 水平比较，差异有统计学意义(P＜0.05)，随着分期的加重，血清 RBP4 水平显著降低(P＜0.05)。 相关分析方面，血清 RBP4 水平与 VAS 评分、ARCO 分期均呈显著负相关(P＜0.05)，与 Harris 评分呈弱正相关(P＜0.05)。ROC 分析，血清 RBP4 水平在诊断股骨头坏死塌陷时的敏感性(64.3%)和特异性(96.8%)，曲线下面积(area under curve, AUC)为 0.895。[结论]随股骨头坏死进展血清 RBP4 水平呈下降趋势，RBP4 可能是诊断 NONFH 潜在的血清标志物。

Abstract:

[Objective] To explore the significance of retinol binding protein-4 (RBP4) for diagnosis of nontraumatic osteonecrosis of fem- oral head (NONFH) . [Methods] A total of 70 patients who were diagnosed of NONFH in Department of Hip Surgery, People's Hospital of Linyi City from August 2021 to December 2021 were selected as the necrosis group, while other 62 healthy subjects matched in age with the necrosis group in the same period were selected as the normal group. The serum RBP4 concentration of the two groups of subjects was detected by en- zyme-linked immunosorbent assay. The general data of the two groups were compared. The serum RBP4 level in the necrosis group was com- pared according to different factors, including etiology, ARCO stage, unilateral or bilateral hips involved and the femoral head uncollapsed or collapsed. The correlations between RBP4 and clinical parameters were searched, and ROC curve was drawn to analyze the diagnostic value of serum RBP4 for NONFH. [Results] The level of serum RBP4 in the necrotic group was significantly lower than that in the normal group (P＜ 0.05) . In the necrosis group, the level of serum RBP4 was significantly lower in patients with femoral head collapse than that in those without femoral head collapse (P＜0.05) , significantly lower in the patients with bilateral femoral head involved than in those with unilateral necrosis (P＜0.05) . There were significant differences in serum RBP4 levels among different ARCO stages (P＜0.05) , the higher stage the lower serum RBP4. In terms of correlation analysis, serum RBP4 level was negatively correlated with VAS score and ARCO stage (P＜0.05) , while was weakly positively correlated with Harris score (P＜0.05) . In term of ROC analysis, serum RBP4 level was used for diagnosis of femoral head ne- crosis and collapse with the sensitivity of 64.3%, specificity of 96.8% and area under curve (AUC) of 0.895. [Conclusion] As progress of NONFH, the serum RBP4 is prone to decline. Therefore, the serum RBP4 is a potential serum marker for the diagnosis of NONFH.