Objective

Osteonecrosis of the femoral head (ONFH) is a devastating disease of the hip joint. Its early diagnosis is crucial to increase the chances of joint preserving, yet difficult due to similarities with osteoarthritis (OA) of the hip in its clinical appearance. The purpose of this study was to enhance the understanding of ONFH and its pathologic processes in contrast to OA and to identify serum biomarkers helping to improve the diagnosis of the disease.

Design

Bone and bone marrow samples were collected from 24 patients diagnosed with OA and 25 patients with ONFH during total hip replacement surgery. RNA was isolated, histological examination, determination of free reactive oxygen species as well as gene expression and biomarker analysis were performed.

Results

Histological analysis revealed differences in the structural and cellular pattern between the groups. Gene expression analysis revealed a significant upregulation for the genes ASPN, COL1A1, COL2A1 and IL6 and a significant downregulation for HIF1A in ONFH compared to OA group. Analysis of serum biomarkers showed significant differences between the groups for asporin and adiponectin. A final logistical regression model including the parameters adiponectin, asporin and HIF 1α was overall significant, explained 34.5 % of variance and classified 74.5 % of the cases correctly.

Conclusion

The combination of adiponectin, asporin and HIF 1α as serum biomarkers revealed a classification accuracy of 74.5 %. The information provided in this study may help to enhance the understanding of pathologic processes in ONFH and to elaborate further aspects of prediction and treatment.

中文翻译：

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生物标志物是否可以区分股骨头坏死和髋关节骨关节炎？– 生化、组织学和基因表达分析

客观的

股骨头坏死（ONFH）是髋关节的破坏性疾病。它的早期诊断对于增加关节保留的机会至关重要，但由于其临床表现与髋关节骨关节炎 (OA) 相似，因此很困难。本研究的目的是加强对 ONFH 及其与 OA 相比的病理过程的理解，并确定有助于改善疾病诊断的血清生物标志物。

设计

在全髋关节置换手术期间，从 24 名诊断为 OA 的患者和 25 名患有 ONFH 的患者中收集骨和骨髓样本。分离RNA，进行组织学检查、游离活性氧的测定以及基因表达和生物标志物分析。

结果

组织学分析揭示了各组之间结构和细胞模式的差异。基因表达分析显示，与 OA 组相比，基因 ASPN、COL1A1、COL2A1 和 IL6 显着上调，而 ONFH 中 HIF1A 显着下调。对血清生物标志物的分析显示，阿孢菌素组和脂联素组之间存在显着差异。最终的逻辑回归模型包括参数脂联素、阿孢菌素和 HIF 1α 总体上是显着的，解释了 34.5% 的方差并正确分类了 74.5% 的病例。

结论

脂联素、阿孢菌素和 HIF 1α 作为血清生物标志物的组合显示分类准确率为 74.5%。本研究中提供的信息可能有助于加深对 ONFH 病理过程的理解，并进一步阐述预测和治疗的方面。