Correlation Between Steroid-induced Osteonecrosis Of Femoral Head And Bone Turnover In Kidney Deficiency And Blood Stasis Type

This study is mainly composed of four parts.The first part is literature review and the second part is to analyze the global steroid-induced femoral head necrosis research progress and hot spots based on bibliometrics and visual analysis.The third part is the clinical research to explore the relationship between SONFH and bone turnover in kidney deficiency and blood stasis type.At last,the fourth part is the research content.Part ? The Global Research status and focus of steroid-induced femoral head necrosis:a study based on Bibliometrics and Visualization Analysis.ObjectiveTo investigate the global research status and focus of steroid-induced femoral head necrosis.MethodsThe scientific citation index of wed of science(wos)was used to search the literature on steroid-induced femoral head necrosis from 2003 to 2018.The source data were statistically analyzed by bibliometrics.Vosviewer software was used to analyze the visual transformation of literature coupling(including author coupling,mechanism coupling and country coupling)and co-occurrence analysis.The research status and trend of rehabilitation after joint replacement in recent years were analyzed.ResultThere were 336 papers included in the study.The number of papers published in the world increased year by year,and the number of published papers in China reached 208,which contributed the most to the global research.and the total citation frequency and h index of the papers were the highest.Shanghai Communications University and the Chinese Academy of traditional Chinese Medicine are the largest contributors to the research.The research topics of steroid-induced osteonecrosis of femoral head can be divided into five categories:clinical trial study,Laboratory Medicine Research,Animal Experimental Research,Pathology Research,Etiology Research.Among them,the research of laboratory medicine is the main research field in recent years,and "expression profile" will become the research hotspot in the future.ConclusionThe study of steroid-induced femoral head necrosis has been increasing in recent years,but it is developing slowly.China is the world' s largest contributor to the study of steroid-induced osteonecrosis of femoral head.Laboratory medicine is a key research field in this field in recent years,in which "expression profile" is the research hotspot in the future.Part ? Clinical study on the correlation between femoral head Necrosis and Bone turnover in Kidney deficiency and Blood stasis typeObjectiveTo investigate the correlation between femoral head necrosis in kidney deficiency and blood stasis type and bone turnover.MethodsThere are 241 cases of osteonecrosis of femoral head diagnosed as kidney deficiency and blood stasis type in our hospital were retrospectively analyzed from January 2016 to January 2019,and 160 patients with knee cruciate ligament injury/meniscus injury were included as control group.The dosage of methylprednisolone(methylprednisolone tablets)was calculated by using time and regimen of hormone.Four biomarkers of bone(type ? collagen amino terminal prolongation peptide,collagen degradation product,osteocalcin n terminal molecular fragment,25-hydroxyvitamin D and Serum phosphorus,Serum magnesium,Serum calcium,phosphorus,magnesium,etc.Serum uric acid,serum alkaline phosphatase,total cholesterol,triacylglycerol,low density lipoprotein cholesterol,high density lipoprotein cholesterol,X-ray results of apolipoprotein Al and apolipoprotein B,in positive frog position of bilateral hip joint were detected on admission.The data of two groups were compared by spss24.0 software.ResultA total of 241 cases were included in the study,including 139 males and 102 females,with an average age of 35.18±11.38 years,while 160 cases in the control group,97 males and 63 females,with an average age of 36.96 ±10.39 years,were matched by sex.The levels of P1NP and ?-CTX,N-MID in the SONFH group were significantly higher than those in the control group(p<0.05).The levels of serum phosphorus,total cholesterol,apolipoprotein A1,HDL,LDL in the SONFH group were significantly higher than those in the control group(p<0.05).There was significant difference in P1NP and ?-CTX between ARCO stages,p<0.05,and the level of P1NP,?-CTX in stage ? patients was higher than that in stage ?,and the ?-CTX level in stage ? was higher than that in stage ?,there was significant difference between the two groups(P<0.05).The level of ?-CTX in the SONFH group was significantly higher in males than in females(p<0.05).There was significant difference in P1NP and ?-CTX between the three age groups(p<0.05).In the SONFH group,alkaline phosphatase was positively correlated with P1NP(r=0.213,P=0.001)and N-MID(r=0.241,P=0.000),and serum phosphorus was positively correlated with the level of P1NP(r=0.186,p=0.003).Total cholesterol was negatively correlated with P1NP(r=-0.174,p=0.008),?-CTX(r= 0.188,p=0.004)and N-MID(r=0.141,p=0.033).Apolipoprotein Al was negatively correlated with P1NP(r=-0.151,p=0.023),?-CTX(r=-0.190,p=0.004),N-MID(r=0.205,p=0.002),apolipoprotein b was negatively correlated with P1NP(r=-0.159,p=0.016).HDL was negatively correlated with P1NP(r=-0.148 p=0.026)and N-MID(r=-0.135 p=0.042).Ldl and P1NP(r=-0.139,p=0.036).Logistic return analysis showed that compared with the control group,the P1NP,?-CTX,N-MID in the experimental group increased,and the corresponding odds ratio score was higher than that in the control group.ConclusionThe levels of P1NP and ?-CTX,N-MID in SONFH patients are higher than those in control group.The levels of P1NP and ?-CXT in stage ? patients in SONFH group are lower than those in stage ? patients,and ?-CTX in stage? are higher than those in stage ?.The six items of lipid in SONFH patients are negatively correlated with P1NP.The development process of SONFH was predicted by detecting the four levels of bone markers.In addition,the disorder of lipid metabolism plays an important role in the pathogenesis of SONFH.