非创伤性股骨头坏死患者的血脂异常：采用倾向评分匹配法与骨关节炎的比较。
Abnormal Lipid Profiles in Nontraumatic Osteonecrosis of the Femoral Head: A Comparison with Osteoarthritis Using Propensity Score Matching.
机构信息
Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.
Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea.
出版信息
J Bone Joint Surg Am. 2022 Apr 6;104(Suppl 2):19-24. doi: 10.2106/JBJS.20.00520.
BACKGROUND
Abnormal lipid metabolism may play an important role in the development of nontraumatic osteonecrosis of the femoral head (ON). By comparing lipid biomarkers in patients with ON and osteoarthritis (OA) after propensity score matching, we sought to reveal (1) common lipid biomarkers that are abnormal in ON regardless of the etiology and (2) specific lipid biomarkers associated with ON according to the etiology.
METHODS
Among 2,268 patients who underwent primary THA, 1,021 patients were eligible for this study. According to the Association Research Circulation Osseous criteria, ON was classified as either idiopathic (n = 230), alcohol-associated (n = 293), or glucocorticoid-associated ON (n = 132). Most common cause of OA was hip dysplasia in 106 patients (47%). We investigated patient lipid profiles by assessing total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), apolipoprotein (Apo) A1 and B, lipoprotein (a) levels and ApoB/A1 ratio. Since age and body mass index affect the lipid profile, we performed propensity score matching to select 304 patients for final analysis and compared lipid profiles between the ON and OA groups. We also compared biomarkers between the ON subgroups and the OA group.
RESULTS
Overall, the ON group showed lower HDL-C (p < 0.001), higher TGs (p = 0.001) levels and higher ApoB/A1 ratio (p = 0.003). Idiopathic ON patients demonstrated lower HDL-C (p = 0.032), higher TGs (p = 0.016), ApoB (p = 0.024) levels and ApoB/A1 ratio (p = 0.008). The alcohol-associated ON subgroup showed lower HDL-C (p < 0.001), higher TGs (p = 0.010) levels and ApoB/A1 ratio (p = 0.030). Finally, the steroid-associated ON subgroup demonstrated lower HDL-C (p = 0.003), higher TGs (p = 0.039), lower TC (p = 0.022), LDL-C (p = 0.021), and ApoA1 (p = 0.004) levels.
CONCLUSIONS
Higher TGs and lower HDL-C levels were associated with nontraumatic ON regardless of the etiology. Additionally, idiopathic ON was associated with higher ApoB levels and ApoB/A1 ratio. Alcohol-associated ON was related to higher ApoB/A1 ratio, and steroid-associated ON paired with decreased TC, LDL-C, and ApoA1 levels. Our findings may support future efforts for prevention and management of nontraumatic ON.
LEVEL OF EVIDENCE
Diagnostic Level III.
背景
异常的脂质代谢可能在非创伤性股骨头坏死（ON）的发展中起重要作用。通过对经倾向评分匹配的 ON 患者和骨关节炎（OA）患者的脂质生物标志物进行比较，我们试图揭示（1）与病因无关的 ON 中异常的共同脂质生物标志物，（2）根据病因与 ON 相关的特定脂质生物标志物。
方法
在 2268 名接受初次 THA 的患者中，有 1021 名符合本研究条件。根据 Association Research Circulation Osseous 标准，ON 分为特发性（n = 230）、酒精相关性（n = 293）或糖皮质激素相关性 ON（n = 132）。106 例（47%）OA 的最常见病因是髋关节发育不良。我们通过评估总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、甘油三酯（TGs）、载脂蛋白（Apo）A1 和 B、脂蛋白（a）水平和 ApoB/A1 比值来研究患者的脂质谱。由于年龄和体重指数会影响脂质谱，我们进行了倾向评分匹配，选择了 304 名患者进行最终分析，并比较了 ON 和 OA 组之间的脂质谱。我们还比较了 ON 亚组和 OA 组之间的生物标志物。
结果
总体而言，ON 组的 HDL-C 水平较低（p < 0.001），TGs 水平较高（p = 0.001），ApoB/A1 比值较高（p = 0.003）。特发性 ON 患者的 HDL-C 水平较低（p = 0.032），TGs 水平较高（p = 0.016），ApoB 水平较高（p = 0.024），ApoB/A1 比值较高（p = 0.008）。酒精相关性 ON 亚组的 HDL-C 水平较低（p < 0.001），TGs 水平较高（p = 0.010），ApoB/A1 比值较高（p = 0.030）。最后，类固醇相关性 ON 亚组的 HDL-C 水平较低（p = 0.003），TGs 水平较高（p = 0.039），TC 水平较低（p = 0.022），LDL-C 水平较低（p = 0.021），ApoA1 水平较低（p = 0.004）。
结论
无论病因如何，较高的 TGs 和较低的 HDL-C 水平与非创伤性 ON 相关。此外，特发性 ON 与较高的 ApoB 水平和 ApoB/A1 比值有关。酒精相关性 ON 与较高的 ApoB/A1 比值有关，而类固醇相关性 ON 与 TC、LDL-C 和 ApoA1 水平降低有关。我们的发现可能支持未来预防和治疗非创伤性 ON 的努力。
证据水平
诊断 III 级。
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