维生素D与激素性股骨头坏死骨代谢相关性初步探究

发布时间：2018-11-24 19:37

【摘要】：目的：分析血清25羟维生素D[25-dihydroxy vitamin D,25(OH)D]在激素性股骨头坏死(Steroid-induced Osteonecrosis Of Femoral Head, SONFH)患者和对照组的外周血中的分布,探讨血清25(OH)D在SONFH中的作用。方法：本研究通过2015年6月至2016年3月于广州中医药大学一附院三骨科入院的通过影像学和临床诊断确诊为SONFH患者病例32例(试验组)以及2012年5月至2014年12月于广州军区广州总医院门诊部体检的正常人50例(对照组),检测血清25(OH)D、P1NP、β-ctx、Ca、P、ALP水平,并记录其年龄、性别、身高、体重,计算体重指数。试验组数据中,按年龄分为3组,分别为19-40岁组、40-60岁组、60～69岁组。按25(OH)D水平分为3组,分别为25(0H)D缺乏组、25(0H)D不足组、25(OH)D充足组。对试验组与对照组相关检测指标进行分析,运用SPSS 17.0版软件进行实验数据检验。观察血清25(0H)D水平与SONFH的相关性。结果：本研究纳入试验组32例,其中男性19例,女性13例,平均年龄43.28±14.46(19-69)岁；对照组50例,其中男性30例,女性20例,平均年龄45.52±18.08(19～69)岁。试验组血清25(OH)D低于对照组,有统计学意义(p0.05),其中试验组血清25(OH)D平均水平为24.57±10.09ng/ml,对照组血清25(OH)D平均水平为37.03±3.40ng/ml。试验组血清Ca低于对照组,有统计学意义(p0.05),其中试验组血清Ca平均水平为2.30±0.14mmol/L,对照组血清Ca平均水平为2.40±0.09mmol/L。试验组血清β-ctx高于对照组,有统计学意义(p0.05),其中试验组血清β-ctx平均水平为0.52±0.30ng/ml,对照组血清β-ctx平均水平为0.36±0.19ng/ml。试验组年龄、血清P1NP、血清ALP略高于对照组,但无统计学意义(p0.05)。试验组身高、血清P略低于对照组,亦无统计学意义(p0.05)。试验组中,在不同年龄阶段,各指标的差异无统计学意义(p0.05)；不同血清25(OH)D水平与各指标差异均无统计学意义(p0.05)。试验组中,血清25(OH)D水平与血清Ca呈正相关(r=0.37,p0.05),与其他指标无相关性。Logistic回归分析显示,在SONFH中存在血清25(0H)D水平不足。两组性别无明显差异,无统计学意义(p0.05) 。结论：SONFH患者血清25(OH)D、Ca均低于对照组,而血清β-ctx高于对照组,且血清25(OH)D水平与Ca呈正相关。初步认为SONFH患者骨代谢发生异常,伴有血清25(0H)D水平降低,应当在接受其他治疗的同时适当补充维生素D,以促进SONFH修复反应,延缓其塌陷进程。
[Abstract]:Objective: to analyze the distribution of serum 25 hydroxyvitamin D [25-dihydroxy vitamin D 25 (OH) D] in peripheral blood of patients with steroid-induced femoral head necrosis (Steroid-induced Osteonecrosis Of Femoral Head, SONFH) and control group, and to explore the role of serum 25 (OH) D in SONFH. Methods: from June 2015 to March 2016, 32 patients with SONFH diagnosed by imaging and clinical diagnosis were admitted to Department of Orthopaedics, first affiliated Hospital of Guangzhou University of traditional Chinese Medicine (trial group) and from May 2012 to December 2014. 50 normal persons (control group) who were examined in outpatient department of Guangzhou General Hospital of Guangzhou military region, The serum levels of 25 (OH) DX P1NPand 尾-ctx,Ca,P,ALP were measured and their age, sex, height, weight and body mass index were calculated. According to the age, the experimental group was divided into 3 groups: 19-40, 40-60, and 60 ~ 69 years old. According to the level of 25 (OH) D, they were divided into 3 groups: 25 (0H) D deficient group, 25 (0H) D deficient group and 25 (OH) D sufficient group. The related indexes of the test group and the control group were analyzed, and the experimental data were tested by SPSS 17.0 software. The correlation between serum 25 (0 H) D level and SONFH was observed. Results: the study included 32 cases in the trial group, including 19 males and 13 females, with an average age of 43.28 卤14.46 (19-69) years, and 50 cases in the control group, including 30 males and 20 females, with an average age of 45.52 卤18.08 (1969) years. The serum 25 (OH) D in the experimental group was significantly lower than that in the control group (p0.05). The average level of 25 (OH) D was 24.57 卤10.09 ng / ml in the experimental group and 37.03 卤3.40 ng / ml in the control group. The serum Ca in the experimental group was significantly lower than that in the control group (p0.05). The average level of serum Ca was 2.30 卤0.14 mmol / L in the experimental group and 2.40 卤0.09 mmol / L in the control group. The serum 尾-ctx in the experimental group was significantly higher than that in the control group (p0. 05). The average serum 尾-ctx level in the experimental group was 0. 52 卤0. 30ng / ml, and in the control group it was 0. 36 卤0. 19ng / ml. Age, serum P 1 NPs and serum ALP in the trial group were slightly higher than those in the control group, but there was no significant difference (p 0. 05). The height and serum P of the trial group were slightly lower than that of the control group (p 0.05). In the experimental group, there was no significant difference in each index in different age period (p0. 05), but there was no significant difference in the level of 25 (OH) D in different serum and every index (p0. 05). In the experimental group, the serum 25 (OH) D level was positively correlated with serum Ca (r = 0.37, p0.05), but not with other indexes. Logistic regression analysis showed that the serum 25 (0H) D level was insufficient in SONFH. There was no significant difference between the two groups (p 0.05). Conclusion: the levels of serum 尾-ctx in patients with SONFH were significantly lower than those in the control group, and the serum 尾-ctx levels were higher than those in the control group. The serum level of 25 (OH) D was positively correlated with Ca. It is suggested that abnormal bone metabolism and decreased serum 25 (0H) D level in patients with SONFH should be supplemented with vitamin D at the same time as other treatments in order to promote SONFH repair response and delay the process of collapse.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

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