Correlation analysis of osteonecrosis of the femoral head with blood lipid and coagulation indexes

Zhao-Xu Jia, Huan-Huan Gao, Ji-Gao Sun, Zhi-Peng Xue, Wen-Long Li, Fan-Yu Fu, Heng-Li Ye, Meng-Ge Song, Wei-Heng Chen

1. Beijing University of Chinese Medicine, Beijing 100029

2. Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102

3. Guizhou University of Chinese Medicine, Guizhou 550025

4. Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100029

Keywords:Osteonecrosis of the femoral head Blood lipid indexes Coagulation indexes correlation analysis

ABSTRACT Objective: To explore the correlation between different types of osteonecrosis of the femoral head and blood lipids and coagulation indexes, in order to provide relevant references for the pathogenesis of osteonecrosis of the femoral head. Methods: 308 cases of ONFH were divided into alcohol group (165 cases), hormone group (113 cases), trauma group (30 cases), and basic data of patients were collected. Blood lipid indicators: total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A, apolipoprotein B; coagulation indicators: activated partial thromboplastin time, plasma prothrombin time, fibrinogen, thrombin time indicators, using analysis of variance method for different types of osteonecrosis of the femoral head and blood lipids, coagulation indicators Search for relevance. Results: 1. Comparison of three groups of blood lipid indicators: total cholesterol and low density lipoprotein cholesterol in the alcohol group were higher than those in the trauma group (P＜0.05); total cholesterol, triglycerides, and low density lipoprotein in the alcohol group The three indexes of cholesterol were higher than those of the hormone group (P＜0.05). There was no significant difference in the serum lipid indexes of the hormone group and the trauma group (P＞0.05). 2. Comparison of three groups of coagulation indicators: hormone The fibrinogen index of the group was higher than that of the trauma group (P＜0.05). There was no significant difference in the coagulation index between the alcohol group and the trauma group (P＞0.05). The coagulation index of the hormone group and the alcohol group was compared. The differences were not statistically significant (P＞0.05). Conclusions: 1. Nontraumatic osteonecrosis of the femoral head (alcoholic, hormonal) patients are characterized by markedly elevated blood lipids (total cholesterol, low density lipoprotein cholesterol) and coagulation (fibrinogen) indicators; 2. Intravascular coagulation and lipid metabolism disorders may be the pathological basis of non-traumatic Osteonecrosis of the femoral head.

1. Introduction

Osteonecrosis of the femoral head (ONFH) is a frequentlyoccurring and difficult-to-treat disease in the orthopedic department. It has a long course of disease and a very high disability rate. Prone to young adults aged 20-50 . It has reached 5 to 7.5 million people, and there are 150,000 to 200,000 new cases each year. The current incidence rate has ranked first in hip disease[1,2,3,4]. There are many influencing factors and complicated mechanisms. The common causes of ONFH are traumatic (most common in hip and neck fractures of femur, hip dislocation and iatrogenic hip injuries) and non-traumatic (mainly alcohol and hormones) And so on, clinical is divided into three types of traumatic, alcoholic, hormonal. Previous studies have shown that the occurrence and development of ONFH is closely related to lipid metabolism and coagulation function[5, 6, 7, 8], but the research on the difference between different types of ONFH and lipid metabolism and coagulation function is insufficient. Therefore, it is necessary to carry out a comparative study of the blood lipids and coagulation indexes of the three types of ONFH patients, which are summarized as follows.

2. Materials and methods

2.1 Clinical data

308 cases of Patients with ONFH treated in the third department of bone and joint of Wangjing Hospital, China Academy of Chinese Medical Sciences from January 2013 to December 2018, including 240 males and 68 females, aged 18 to 70 (43.47 ± 12.56 years); course The shortest is 1 month, the longest is 48 months, and the average is 16.78 months. 113 cases were unilateral and 195 cases were bilateral. Inclusion criteria (consistent at the same time): ① The diagnostic criteria were based on the diagnostic criteria for ONFH proposed by Professor Mont[9]. ② meet the above diagnostic criteria; ③ enter the etiology information, blood lipids, coagulation index data; ④ age ≥ 18 years old. ⑤ Western medicine diagnosed hormonal ONFH, alcoholic femoral ONFH, and traumatic ONFH. Exclusion criteria: ① Exclude missing values.

2.1.1 Composition ratio of different groups

The distribution of the three groups of patients was increased according to the order of the trauma group, hormone group, and alcohol group. The alcohol group accounted for the largest proportion, which was significantly higher than the other two groups. The largest proportion (Table 1).

Table 1 Composition of different groups of 308 patients with ONFH [Case, (%)]

2.2 Method

The HIS system of Wangjing Hospital was used to retrieve patients admitted to the hospital from January 2013 to December 2018 with "ONFH" diagnosed in the three departments of orthopedics, and collected basic information such as age, gender, and etiology of all subjects based on medical records. And blood lipid indicators measured on the first day of admission: total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), apolipoprotein A (ApoA), Lipoprotein B (ApoB); coagulation indicators: activated partial thromboplastin time (APTT), plasma prothrombin time (PT), fibrinogen (FIB), thrombin time (TT) indicators, the above physical and chemical indicators are the patient's After 12 to 14 hours of fasting, venous blood was collected and submitted for examination at about 8 am. Blood lipid indexes were tested by Roche Cobas8000-701 biochemical analyzer, and blood coagulation indexes were tested by Hisemex CA-7000 coagulometer. The final data was collected by two graduate students through the two-machine dual-use Excel spreadsheet and proofread by software.

2.3 Statistical processing

SPSS 25.0 statistical software was used to process and analyze the included data. For comparison of blood lipids and coagulation indexes in the alcohol group, hormone group and trauma group,In the first step, one-way ANOVA was used, and further tests were performed using the least squares method (LSD method) to compare the two pairs. The measurement data was expressed as (Mean ± SD), and Statistical significance with P ＜0.05.

3. Results

3.1 Comparison of blood lipid indexes in alcohol group, hormone group and trauma group

The differences between the TC, TG, and LDL groups in the trauma, alcohol, and hormone groups were statistically significant (F = 9.039, P = 0.000; F = 3.478, P = 0.032; F = 6.592, P = 0.002); HDL The differences between the groups were not statistically significant (F = 1.845, P = 0.160); further testing, TC: Trauma group compared with alcohol group P = 0.004, the difference was statistically significant, compared with trauma group and hormone group P = 0.509 The difference was not statistically significant. The difference between the alcohol group and the hormone group was P = 0.000, and the difference was statistically significant. TG: The comparison between the trauma group and the alcohol group was P = 0.183, and the difference was not statistically significant. The difference was not statistically significant. The difference between the alcohol group and the hormone group was P = 0.012, and the difference was not statistically significant. LDL: The comparison between the trauma group and the alcohol group was P = 0.002, and the difference was statistically significant. The difference was not statistically significant. Compared with the alcohol group and the hormone group, P = 0.009, the difference was statistically significant (see Table 2).

Table 2 Comparison of blood lipid indexes in alcohol group, hormone group and trauma group(Mean±SD,mmol/L)

3.2 Comparison of blood lipid indexes in alcohol group, hormone group and trauma group

The differences between the ApoAI, ApoB, and ApoB / ApoA groups in the trauma, alcohol, and hormone groups were not statistically significant (F = 1.706, P = 0.183; F = 0.917, P = 0.401; F = 1.371, P = 0.255 ) (See Table 3).

Table 3 Comparison of serum lipoprotein indexes in alcohol group, hormone group and trauma group(Mean±SD,g/L)

3.3 Comparison of coagulation indexes in alcohol group, hormone group and trauma group

There were statistically significant differences in FIB between the trauma group, alcohol group, and hormone group (F = 3.391, P = 0.035); there were no statistically significant differences between the APTT, PT, and TT groups (F = 0.499, P (= 0.608; F = 0.812, P = 0.445; F = 0.121, P = 0.886); Further examination, FIB: The comparison between the traumatic group and the alcohol group was P = 0.090, the difference was not statistically significant. The comparison between the traumatic group and the hormone group was P = 0.013. The difference was statistically significant. Compared with the alcohol group and the hormone group, P = 0.132, the difference was not statistically significant (see Table 4).

Table 4 Comparison of four indexes of coagulation in alcohol group, hormone group and trauma group(Mean±SD)

4. Discussion

4.1 Chinese Medicine's Understanding of the ONFH

Although there is no statement about abnormal lipid metabolism and coagulation function in the theory of Chinese medicine, there have been discussions about "paste" and "fat" in the Yellow Emperor's Canon of Medicine, and according to its clinical symptoms, disease position, and etiology, the ONFH is necrotic in The classics of Chinese medicine can be attributed to Paralysis, which belongs to "Hip Bone Paralysis", which means is Poor circulation, and "Poor circulation is pain". Moreover, previous studies have found that [10, 11, 12] abnormal lipid metabolism is one of the main material foundations of sputum turbidity. Many clinical manifestations of diseases with abnormal lipid metabolism are also related to sputum syndrome and sputum stasis syndrome. It is considered that "phlegm and blood stasis are homologous" and "phlegm can cause stasis". Older experts such as LIU Bailing[13], a well-known orthopaedic specialist, and YUAN Hao[14] also believed that ONFH was mainly caused by "stasis". And through years of clinical practice, we found that in addition to non-traumatic ONFH, In addition to "stasis", there are also symptoms of "phlegm", such as heavy joints, fat eating, greasy fur, slippery pulses, etc. The results of this study indicate that alcoholic and hormonal ONFH is characterized by markedly elevated blood lipid (TC, LDL), and coagulation (FIB) indicators. Based on this, the current "sputum and blood stasis treatment" method should become a non-traumatic treatment The most basic rule of ONFH.

4.2 Relationship between alcoholic ONFH and fat metabolism

The results of this study showed that the blood lipids and coagulation indexes of patients with hormonal, alcoholic, and traumatic ONFH were compared between groups. Results: The TC and LDL indicators of the alcohol group were higher than those of the trauma group, P ＜0.05 was statistically significant Significance; the three indicators of TC, TG, and LDL in the alcohol group were higher than those in the hormone group, P ＜0.05 was statistically significant. This indicates that alcoholic ONFH is characterized by a significant increase in blood lipid (TC, TG, LDL) indicators, which is consistent with BI Haidi[5] and our previous research reports [6, 15].TCM classics "Essays on the Sources of Diseases" have long recorded: "Alcohol is poisonous, drinking too much, poisonous heat will infiltrate the meridians and viscera and cause various diseases." Alcoholic evil is similar to lurking evil spirit. Excessive alcohol consumption causes the occurrence of "phlegm, dampness, and blood stasis" and blocks the operation of qi and blood, so it can cause this disease. In addition, modern medical research[16] shows that long-term excessive drinking can cause the femoral head blood supply failure or osteocyte degeneration, leading to the death of vital components in the bone, and eventually cause the pathological process of ONFH. Ethanol can not only inhibit the proliferation and differentiation of osteoblasts, accelerate osteoblast apoptosis, but also induce precursor cells to tend to adipogenic differentiation, leading to imbalance of bone homeostasis[17]. At the same time, ethanol can also cause blood lipid metabolism disorders, promote fat production, increase internal bone pressure, and cause blood supply in the femoral head to be blocked[18, 19, 20, 21]. It can be seen that for people who have been drinking for a long time, regular detection of blood lipid (TC, TG, LDL) indicators can help the early prevention and treatment of alcoholic ONFH; and alcoholic ONFH is closely related to blood lipid indicators, so lipid metabolism disorders It may be involved in its occurrence and development mechanism, and clinical attention should be paid to further research.

4.3 Relationship between hormonal ONFH and intravascular coagulation

The results of this study showed that the blood lipids and coagulation indexes of hormonal, alcoholic, and traumatic ONFH patients were compared between groups. Results: The FIB index of the hormonal group was higher than that of the trauma group (P ＜0.05). The results indicate that hormonal ONFH is characterized by a marked increase in the coagulation index (FIB), which is consistent with our previous research reports[6]. Although there is no concept of hormone in ancient Chinese medicine books, but according to its pharmacological properties, it can be considered that the pharmacological properties of hormones are fiery, and highdose or long-term application of hormones, that is, "excessive fire will consume Qi", causes Qi deficiency, which can cause slow blood flow. And loss of fluid, blood operation has obstacles, can cause Symptoms of blocked meridians and collaterals. In addition, modern research[22, 23, 24, 25] showed that the damage caused by hormones to microvascular endothelial cells can not only increase the local coagulation activity, form microthrombosis, occlusion of the blood vessels, cause necrosis of the femoral head in the dominating area, but also damage the microvascular endothelium. Cells produce a large number of reactive oxygen species, which reduces the synthesis of vasodilators, further exacerbating the damage to endothelial cells themselves and necrosis of osteocytes and bone marrow. It can be seen that people with long-term use of hormones regularly test four coagulation factors, and pay attention to the FIB index, which is helpful for the early prevention and treatment of hormonal ONFH; and hormonal ONFH is closely related to the coagulation index (FIB), so intravascular coagulation function Obstacles may be involved in its occurrence and development mechanism, and clinical attention should be paid to further research.

4.4 Weaknesses and Outlook

The shortcomings of this study are: the sample size of the case is small and only originated from our hospital, the source of the disease is relatively single, the coverage area is not wide enough, there may be selection limitations, and the representation is not strong enough. There may be correlation bias. In the later period, it is necessary to further expand the sample size and conduct multi-center, largesample surveys in order to obtain more objective and comprehensive results.