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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (01) : 24 -29. doi: 10.3877/cma.j.issn.1674-134X.2024.01.004

临床论著

髋关节发育不良合并骨关节炎患者血清标志物表达
孙智1,†(), 张方青1   
  1. 1. 054000　邢台市第三医院
  • 收稿日期:2023-06-30 出版日期:2024-02-01
  • 通信作者: 孙智
  • 基金资助:
    邢台市重点研发项目(2021ZC113)

Expression of serum biomarkers in patients with hip dysplasia complicated with osteoarthritis

Zhi Sun1,†(), Fangqing Zhang1   

  1. 1. The Third Hospital of Xingtai, Xingtai 054000, China
  • Received:2023-06-30 Published:2024-02-01
  • Corresponding author: Zhi Sun
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引用本文：

孙智, 张方青. 髋关节发育不良合并骨关节炎患者血清标志物表达[J]. 中华关节外科杂志(电子版), 2024, 18(01): 24-29.

Zhi Sun, Fangqing Zhang. Expression of serum biomarkers in patients with hip dysplasia complicated with osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(01): 24-29.

目的

探讨血清肝素结合性表皮生长因子(HB-EGF)、CC类趋化因子配体5(CCL5)在髋关节发育不良(DDH)并发骨关节炎患者中表达情况及临床意义。

方法

本研究纳入邢台市第三医院收治的180例DDH患者设为研究组，排除合并血液系统疾病、代谢性疾病、风湿性免疫疾病、重要脏器功能衰竭、恶性肿瘤、全身炎性疾病以及长期使用免疫抑制剂、糖皮质激素、非甾体类抗炎药的患者，根据有无并发骨关节炎将其分为并发组(72例)和未并发组(108例)。另同期选取180例健康体检者设为对照组。所有受试者均检测血清HB-EGF、CCL5水平。根据Tonnis分级标准判定骨关节炎严重程度，对比骨关节炎不同严重程度DDH患者的血清HB-EGF、CCL5水平，采用多因素logistic回归分析DDH患者并发骨关节炎的影响因素，并采用Spearman相关性分析法分析血清HB-EGF、CCL5表达水平与DDH患者骨关节炎严重程度的关系。

结果

研究组血清HB-EGF、CCL5水平高于对照组(t＝29.933、14.021，均为P<0.001)；并发组年龄、Crowe分型Ⅲ～Ⅳ型患者占比及血清HB-EGF、CCL5水平均高于未并发组(t＝8.857、χ2＝7.018、t＝12.025、t＝8.536，均为P<0.05)；年龄[比值比(OR)＝1.504，95%置信区间(CI)(1.132，2.457)，P＝0.014]、Crowe分型[OR＝2.347，95%CI(1.568，3.742)，P<0.001]、血清HB-EGF水平[OR＝1.994，95%CI(1.472，2.993)，P<0.001]、血清CCL5水平[OR＝1.548，95%CI(1.055，2.602)，P＝0.007]均是DDH患者并发骨关节炎的独立影响因素；骨关节炎不同严重程度DDH患者血清HB-EGF、CCL5水平差异有统计学意义(F＝27.255、12.855，均为P<0.05)，2级和3级均高于1级(2级t＝5.599、5.749，3级t＝3.669、3.803，均为P<0.05)，3级高于2级(t＝2.157、2.232，均为P<0.05)；血清HB-EGF、CCL5表达水平与DDH患者骨关节炎严重程度呈正相关(r＝0.628、0.497，均为P<0.05)。

结论

血清HB-EGF、CCL5在DDH患者中表达上调，在DDH并发骨关节炎中表达水平更高，与骨关节炎严重程度呈正相关，且是DDH患者并发骨关节炎的独立影响因素。

关键词: 发育性髋关节发育不良, 骨关节炎, 肝素结合EGF样生长因子, 趋化因子CCL5, 数据相关性
Objective

To investigate the expression and clinical significance of serum heparin binding epidermal growth factor (HB-EGF) and CC chemokine ligand 5 (CCL5) in patients with hip dysplasia (DDH) complicated with osteoarthritis.

Methods

This study included 180 DDH patients admitted to Xingtai Third Hospital as the study group, excluding patients with concomitant hematological diseases, metabolic diseases, rheumatic immune diseases, important organ failure, malignant tumors, systemic inflammatory diseases, as well as long-term use of immunosuppressants, glucocorticoids, and nonsteroidal anti-inflammatory drugs. They were divided into the complicated group (72 cases) and the non complicated group (108 cases) according to the presence or absence of osteoarthritis. In addition, 180 healthy people were selected as the control group at the same time. Serum HB-EGF and CCL5 levels of all subjects were detected. The severity of osteoarthritis was determined according to the Tonnis grading standard, and the levels of serum HB-EGF and CCL5 in DDH patients with different severity of osteoarthritis were compared. The influencing factors of osteoarthritis in patients with DDH were analyzed by multivariate logistic regression, and the relationship between the expression levels of serum HB-EGF and CCL5 and the severity of osteoarthritis in patients with DDH was analyzed by Spearman correlation analysis.

Results

The levels of serum HB-EGF and CCL5 in the study group were higher than those in the control group(t =29.933, 14.021, both P<0.001). Age, proportion of patients with Crowe type Ⅲ-Ⅳ and serum HB-EGF and CCL5 levels in the complicated group were higher than those in the uncomplicated group (t =8.857, χ2=7.018, t =12.025, t =8.536, all P<0.05). Age[odds ratio (OR)=1.504, 95% confidence interval (CI) (1.132, 2.457), P=0.014], Crowe's classification[OR =2.347, 95%CI (1.568, 3.742), P<0.001], serum HB-EGF [OR =1.994, 95%CI (1.472, 2.993), P<0.001] and serum CCL5 [OR =1.548, 95%CI (1.055, 2.602), P =0.007]were the independent influencing factors of osteoarthritis in DDH patients. The levels of serum HB-EGF and CCL5 in DDH patients with different severity of osteoarthritis were significantly different (F =27.255, 12.855, both P<0. 05), and level two and three were higher than level one (level two t =5.599, 5.749, level three t=3.669, 3.803, all P <0.05), and level three was higher than level two (t =2.157, 2.232, both P<0.05). The expression levels of serum HB-EGF and CCL5 were positively correlated with the severity of osteoarthritis in DDH patients (r =0.628, 0.497, both P<0.05).

Conclusion

Serum HB-EGF and CCL5 are up-regulated in patients with DDH, and the expression level is higher in patients with DDH complicated with osteoarthritis, which is positively correlated with the severity of osteoarthritis, and they are independent influencing factor for patients with DDH complicated with osteoarthritis.

Key words: Developmental dysplasia of the hip, Osteoarthritis, Heparin-binding EGF-like growth factor, Chemokine CCL5, Correlation of data
表1 研究组与对照组临床资料
Table 1 Clinical data of the study group and the control group
组别Groups 例数Number of cases 性别[例(%)]Gender 年龄[岁，(±s)]Age BMI[kg/m2，(±s)] HB-EGF[mg/L，(±s)] CCL5[ng/L，(±s)]
男Male 女Female
研究组Study group 180 64(35.6) 116(64.4) 39.3±6.6 23.1±2.1 15.3±5.0 429.2±63.1
对照组Control group 180 69(38.3) 111(61.7) 38.7±8.1 23.2±2.2 3.9±1.2 339.5±58.3
统计值Statistical value   χ2＝0.298 t＝0.797 t＝0.390 t＝29.933 t＝14.021
P值   >0.05 >0.05 >0.05 <0.001 <0.001
表2 并发组和未并发组临床资料比较
Table 2 Comparison of clinical data between concurrent and non concurrent groups
临床资料Clinical data 并发组Complication group 未并发组Non complication group 统计值Statistical value P值
例数Number of cases 72 108    
性别[例(%)]Gender        
男Male 22(30.6) 42(38.9)    
女Female 50(69.4) 66(61.1) χ2＝1.309 >0.05
年龄[岁，(±s)]Age (years) 44.8±5.1 36.3±6.9 t＝8.857 <0.001
BMI[kg/m2，(±s)] 23.2±2.3 22.9±2.2 t＝0.863 >0.05
病变位置[例(%)]Location of lesion        
单侧病变Unilateral lesion 52(72.2) 73(67.6)    
双侧病变Bilateral lesions 20(27.8) 35(32.4) χ2＝0.436 >0.05
Crowe分型[例(%)]Crowe classification        
Ⅰ～Ⅱ 33(45.8) 71(65.7)    
Ⅲ～Ⅳ 39(54.2) 37(34.3) χ2＝7.018 0.008
HB-EGF [mg/L，(±s)] 20.8±6.0 11.7±4.1 t＝12.025 <0.001
CCL5 [ng/L，(±s)] 476.3±61.0 397.8±60.0 t＝8.536 <0.001
表3 DDH患者并发骨关节炎的多因素logistic回归分析
Table 3 Multivariate logistic regression analysis of osteoarthritis in DDH patients
变量Variables β值 SE Wald χ2值 P值 OR值 95% CI
年龄Age 0.408 0.166 6.041 0.014 1.504 (1.132，2.457)
Crowe Ⅰ～Ⅱ － － － － 参考 －
Crowe Ⅲ～Ⅳ 0.853 0.272 9.835 <0.001 2.347 (1.568，3.742)
HB-EGF 0.690 0.214 10.396 <0.001 1.994 (1.472，2.993)
CCL5 0.437 0.159 7.554 0.007 1.548 (1.055，2.602)
表4 骨关节炎不同严重程度DDH患者血清HB-EGF、CCL5水平(±s)
Table 4 Serum HB-EGF and CCL5 levels in DDH patients with different severity of osteoarthritis
病情分级Disease grading 例数Number of cases HB-EGF(mg/L) CCL5(ng/L)
1级Level 1 49 18.2±4.4 450.6±71.1
2级Level 2 18 25.2±4.9a 518.9±56.3a
3级Level 3 5 29.8±2.8ab 574.0±37.8ab
F值   27.255 12.855
P值   <0.001 <0.001
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