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Effect of blood biochemical factors on nontraumatic necrosis of the femoral head

Logistic regression analysis

Effekte biochemischer Faktoren auf die nichttraumatische Hüftkopfnekrose

Logistische Regressionsanalyse

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Abstract

Objective

This case–control study aimed to identify the risk factors of nontraumatic necrosis of the femoral head (NONFH).

Methods

In all, 242 patients with NONFH treated at the hip disease research center of our hospital between March 2012 and October 2015 were included. After excluding 19 patients with tumor or tuberculosis, 223 patients were enrolled. Controls comprised 223 healthy persons selected from our hospital database. Single-factor variance analysis and t test were performed to select the index of statistical significance. The 95% confidence interval (95% CI) and normal range of the selected indicators were compared, and abnormal related indexes were selected from the femoral head necrosis group. The selected indicators were based on the increase or decrease to locate the risk indicators and render their corresponding assignment. Logistic regression analysis of the risk factors was performed after the assignment.

Results

The necrotic group of patients with decreased carbon dioxide combining power (CO2CP), increased total cholesterol, increased low-density lipoprotein, and decreased high-density lipoprotein levels had statistically significant partial regression coefficient values and the odds ratios were 73.5 (95% CI 24.59–219.74), 7.15 (3.51–14.85), 633.07 (121.7–3304.78), and 20.11 (9.36–43.8), respectively, indicating that these are strong risk factors for NONFH.

Conclusions

Abnormal lipid metabolism is a strong risk factor of NONFH. Lipid examination can be used as a screening tool for NONFH in high-risk populations, for alcoholism, and many hormone applications. The decreased CO2CP was associated with NONFH, and bone microcirculation was considered to possibly lead various conditions such as ischemia and hypoxia-related bone metabolic acidosis. However, further study is needed.

Zusammenfassung

Ziel

Das Ziel dieser Fall-Kontroll-Studie ist es, die Risikofaktoren für eine nichttraumatische Hüftkopfnekrose (NONFH) zu identifizieren.

Methoden

In die Studie wurden insgesamt 242 Patienten mit NONFH eingeschlossen, die am Behandlungszentrum für Hüfterkrankungen in unserer Klinik zwischen März 2012 und Oktober 2015 behandelt wurden. Nach Ausschluss von 19 Patienten mit Tumoren oder Tuberkulose nahmen 223 Patienten an der Studie teil. Die Kontrollgruppe bestand aus 223 gesunden Personen, die aus unserer Klinikdatenbank ausgewählt wurden. Eine einfaktorielle Varianzanalyse sowie ein t‑Test wurden durchgeführt, um den Index für die statistische Signifikanz zu wählen. Das 95% Konfidenzintervall (95% CI) und die normale Spannweite der ausgewählten Indikatoren wurden verglichen, und abnormale Indices wurden aus der Hüftkopfnekrose-Gruppe selektiert. Die selektierten Indikatoren basierten auf der Erhöhung oder Verminderung, um die Risikofaktoren zu finden und diese mit der jeweiligen Zuordnung in Beziehung zu setzen. Nach der Zuordnung wurde eine logistische Regressionsanalyse der Risikofaktoren durchgeführt.

Ergebnisse

Die nekrotische Patientengruppe mit erniedrigten CO2CP-Werten („carbon dioxide combining power“), erhöhten Gesamt-Cholesterinwerten, erhöhtem Lipoprotein mit geringer Dichte („low-density lipoprotein“, LDL) und erniedrigtem Lipoprotein mit hoher Dichte („high-density lipoprotein“, HDL) hatte statistisch signifikante partielle Regressionskoeffizienzwerte, wobei die Odds-Ratios 73,5 (95% CI 24,59–219,74), 7,15 (3,51–14,85), 633,07 (121,7–3304,78) bzw. 20,11 (9,36–43,8) betrugen, was darauf hinweist, dass diese Werte große Risikofaktoren für eine NONFH darstellen.

Schlussfolgerung

Ein abnormaler Lipidstoffwechsel ist ein großer Risikofaktor für eine NONFH. Eine Lipiduntersuchung kann als Screeningmethode für eine NONFH in Hochrisikopopulationen, bei Alkoholismus und vielen hormonellen Anwendungen verwendet werden. Der erniedrigte CO2CP-Wert war mit einer NONFH assoziiert, und die Knochenmikrozirkulation könnte zu unterschiedlichen Erkrankungen, wie einer Ischämie und einer hypoxiebedingten metabolischen Azidose, führen. Hierzu sind jedoch weitere Studien nötig.

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Funding

This study was supported by the National Science Foundation of China (81473704) and the Science and Technology Project of Henan Province (162102310364). None of the authors of this paper have any financial and personal relationships with other people or organizations that could inappropriately influence the work.

Author information

Authors and Affiliations

  1. Medical Center for the Hip, Luoyang Orthopedic–Traumatological Hospital, No. 82 South Qiming Road, 471002, Luoyang, China

    Ying Zhang, Ruibo Sun, Leilei Zhang & Youwen Liu

  2. The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510006, Guangzhou, China

    Lizhi Feng

Authors
  1. Ying Zhang
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  2. Ruibo Sun
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  3. Leilei Zhang
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  4. Lizhi Feng
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Corresponding author

Correspondence to Youwen Liu.

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Conflict of interest

Y. Zhang, R. Sun, L. Zhang, L. Feng, and Y. Liu declare that they have no competing interests.

This study was approved by the regional ethics committee of our hospital, and all the patients signed informed consent forms. Informed consent was obtained from all individual participants included in the study.

Additional information

Ying Zhang and Ruibo Sun contributed equally to this work.

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Zhang, Y., Sun, R., Zhang, L. et al. Effect of blood biochemical factors on nontraumatic necrosis of the femoral head. Orthopäde 46, 737–743 (2017). https://doi.org/10.1007/s00132-017-3408-4

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  • DOI: https://doi.org/10.1007/s00132-017-3408-4

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