非创伤性股骨头坏死检测血清Hcy的临床意义△

Clinical significance of serum homocysteine detection in non-traumatic necrosis of femoral head

摘要:

[目的]探讨检测血清中同型半胱氨酸（homocysteine, Hcy）早期临床诊断非创伤性股骨头坏死（non-traumatic osteo- necrosis of the femoral head, NONFH） 的应用价值。[方法] 2023 年 1 月—2023 年 10 月本院在就诊的 73 例 NONFH 患者和同期查体的 68 例健康人纳入本研究，采用酶联免疫吸附分析（enzyme-linked immunosorbent assay, ELISA）测定受试者血清中的 Hcy 水平。比较患者与正常人，以及患者按临床指标分层分组 Hcy 水平的差异，分析 Hcy 水平与临床相关资料的相关性，ROC 分析 Hcy 水平判断是否 NONFH 的价值。[结果]NONFH 患者血清中的 Hcy 水平显著高于正常人 [(36.3±11.8) nmol/ml vs (19.2±13.7) nmol/ml, P＜0.001]。73 例患者分层比较表明，双侧病变的 Hcy 显著高于单侧病变 [(44.2±5.2) nmol/ml vs (29.4±11.7) nmol/ml, P＜ 0.001]；股骨头塌陷者 Hcy 显著高于未塌陷者 [(43.7±4.5) nmol/ml vs (24.4±10.1) nmol/ml, P＜0.001]；随着 ARCO 分期的加重，血清 Hcy 水平显著升高，不同分期之间差异均有统计学意义 [I/II/III/IV, (15.1±2.4) nmol/ml vs (29.8±9.2) nmol/ml vs (42.1±4.4) nmol/ml vs (46.2±3.5) nmol/ml, P＜0.001]。相关分析表明：血清 Hcy 水平与 VAS 评分（r=0.747, P＜0.001） 和 ARCO 分期（r=0.791, P＜0.001） 呈显著正相关，血清 Hcy 水平与 Harris 评分呈显著负相关（r=-0.706, P＜0.001）。ROC 分析表明，血清 Hcy 水平判断 NONFH 的敏感性为 67.1%，特异性为 85.3%，曲线下面积（AUC）为 0.818。[结论]NONFH 患者血清中的 Hcy 水平显著升高，并与疾病严重程度呈正相关，表明 Hcy 是 NONFH 疾病的潜在诊断标志物。

Abstract:

[Objective] To investigate the clinical value of serum homocysteine (Hcy) detecting in the early diagnosis of nontraumatic necrosis of the femoral head (NONFH). [Methods] From January 2023 to October 2023, 73 patients with NONFH and 68 healthy subjects who underwent routine physical examination during the same period were included in this study. Serum Hcy levels were determined by enzymelinked immunosorbent assay (ELISA). The difference of Hcy level between patients and normal controls, as well as groups stratified by clinical indicators in the patients was compared, and the correlation between Hcy level and relevant clinical data was analyzed, and the value of Hcy level to determine whether NONFH was conducted by receiver operator characteristic curve (ROC). [Results] The serum Hcy level in NONFH patients was significantly higher than that in normal controls [(36.3±11.8) nmol/ml vs (19.2±13.7) nmol/ml, P＜0.001]. In terms of stratified comparison of 73 patients, the Hcy in the bilateral affected was significantly higher than that in the unilateral involved [(44.2±5.2) nmol/ml vs (29.4±11.7) nmol/ml, P＜0.001], while the Hcy in the femoral head collapse was significantly higher than that in the non-collapsed [(43.7±4.5) nmol/ml vs (24.4±10.1) nmol/ml, P＜0.001]. With the upgrade of ARCO classification, the serum Hcy level increased significantly, which was of statistically significant differences among different stages [I/II/III/IV, (15.1±2.4) nmol/ml vs (29.8±9.2) nmol/ml vs (42.1±4.4) nmol/ml vs (46.2±3.5) nmol/ml, P＜0.001]. In term of correlation analysis, the serum Hcy level was of significantly positive correlation with VAS score (r=0.747, P＜0.001) and ARCO staging (r=0.791, P＜0.001), whereas significantly negative correlation with Harris score (r=-0.706, P＜0.001). As result of ROC analysis, the sensitivity and specificity of serum Hcy level for predicting NONFH was of 67.1%, and 85.3%, with area under curve (AUC) of 0.818. [Conclusion] Serum Hcy level in NONFH is significantly elevated and positively correlated with disease severity, suggesting that Hcy maybe a potential diagnostic marker for NONFH.