To The Mechanism Of Non-traumatic Femoral Head Necrosis Caused By Blood Stasis Based On PI3K/AKt Signaling Pathway

Objective: The epidemiological survey was used to determine the distribution o f TCM constitutions in NONFH patients,and the database was improved.;Mol ecular experiments were conducted to study the expression levels of PI3 K,AKt,VEGF and other related genes in the blood of NONFH patients with blood st asis and the control group,so as to clarify the correlation between angiogenesis and NONFH and explain its regulatory mechanism.It provides scientific basis for further clarifying the pathogenesis,early differentiation diagnosis and progn osis of NONFH in blood stasis.Methods: From July 2017 to October 2018,NONFH patients were investigated and treated in gansu longzhong bonesetting hospital,and fresh blood samples were collected and white blood cells were extracted.A total of 73 cases were collected;One case with incomplete data was excluded and 72 cases were incl uded.Blood stasis NONFH meter was used in 19 cases.There were 20 cases of mild and quality;Blood samples from non-consanguineous healthy people wer e collected at the same time as the control group.10 cases of blood stasis,N ONFH and non-consanguineous healthy people were selected by random numbe r method.On the basis of previous experimental studies,the experimental indica tors were determined,and the expressions of PI3 K,AKt and VEGF in leukocy tes in each group were detected by rt-qpcr,and the results were analyzed with SPSS 22.0.Results:1.Clinical epidemiological studies(1)This investigation 72 people,a single constitution of 66 people,and the co nstitution of 6 people.Among the single constitutions,18(27.27%)had mild co nstitutions and 48(72.73%)had biased constitutions.In the biased constitution,blood stasis,phlegm and dampness,and qi deficiency occurred frequently,acco unting for 28.79%,15.15% and 12.12% respectively.(2)In this survey,there were 72 patients,including 39 males(54.17%)and 33females(45.83%).The majority of patients were aged over 40 years old,acco unting for 59 patients(81.94%).Patients with blood stasis can be seen in all ag es,mainly between 40 and 70 years old.The distribution of phlegm-dampness a nd qi-asthenia was concentrated in 50-70 years old.(3)The etiological composition of the investigation was as follows: idiopathic> hormone > alcohol,accounting for 43.05%,33.33% and 23.61% respectivel y.(4)According to the statistical analysis of the involved femoral head according to the imaging data,the incidence of right hip(59.57%)and left hip(40.43%)was 94 in 72 patients.According to ARCO staging analysis,the largest proport ion of stage 3 and 4 was 76 hips,accounting for 80.85%.Among them,stage4 was 49 hips,accounting for 52.13%.(5)According to the observation of the average course of disease according to the educational level,it is found that the average course of disease gradually d ecreases from 7.22 years to 2.69 years from the primary school education or l ess to the college education or above.The average disease duration was 5.89 ye ars for agricultural population and 4.77 years for other non-agricultural populati on.2.Laboratory study onIn the constitution group,the difference of VEGF gene in patients with bl ood stasis,patients with mild blood stasis and normal people was statistically s ignificant(P<0.05).The difference of PI3 K gene between patients with blood st asis and those with mild blood stasis was statistically significant(P<0.05).There was no statistically significant difference of AKt gene between patients with b lood stasis and those with mild blood stasis and normal people(P>0.05).Conclusion:(1)This investigation further verified that blood stasis was the high incidence t ype of NONFH.(2)The NONFH patients in this area were mainly middle-aged and elderly,wit h severe disease(high stage)and long course of disease.(3)In the constitution group,the average course of disease and the age of ons et of blood stasis were lower than other biased constitutions,which may be si gnificantly related to the susceptibility and symptoms of blood stasis diseases.(4)In the peripheral blood of patients with blood stasis NONFH: the high expr ession of VEGF gene suggests that in the femoral head of patients with blood stasis,local ischemia and hypoxia may be severe,which stimulates the body t o mobilize the release of systemic VEGF into the peripheral blood to compens ate the local area and promote repair.PI3 K is positively correlated with VEGF,suggesting that PI3 K may be an upstream regulator of VEGF.