文献类型：期刊文献

中文题名：儿童股骨头缺血性坏死术后血运重建效果与关节液VEGF、IGF-1及TGF-β_(1)水平的关系

英文题名：Relationship between postoperative revascularization efficacy and levels of VEGF,IGF-1 and TGF-β_(1) in joint synovial fluid in children with Perthes Disease

作者：梁恬[1];张琪[2];马利海[2];郎爱强[2];姚川江[2];徐兰萍[3]

第一作者：梁恬

机构：[1]甘肃中医药大学中医临床学院,兰州730000;[2]甘肃中医药大学附属医院小儿骨科,甘肃兰州730000;[3]甘肃中医药大学附属医院皮肤科,甘肃兰州730000

第一机构：甘肃中医药大学中医临床学院

年份：2025

卷号：50

期号：10

起止页码：1263

中文期刊名：解放军医学杂志

外文期刊名：Medical Journal of Chinese People's Liberation Army

收录：;北大核心:【北大核心2023】；

基金：甘肃省自然科学基金(23JRRA1205)。

语种：中文

中文关键词：股骨头缺血性坏死;血管内皮生长因子;胰岛素样生长因子;转化生长因子-β_(1);血运重建

外文关键词：ischemic necrosis of femoral head;vascular endothelial growth factor;insulin-like growth factor 1;transforming growth factor-β_(1);revascularization

摘要：目的探究股骨头缺血性坏死(又称Perthes病)患儿关节液中血管内皮生长因子(VEGF)、胰岛素样生长因子1(IGF-1)、转化生长因子-β_(1)(TGF-β_(1))水平与术后血运重建效果的关系,以期为后续诊疗提供依据。方法回顾性选取2023年1月-2024年6月甘肃中医药大学附属医院收治的262例Perthes病患儿,按术后血运重建效果分为血运重建良好组(n=228)与血运重建欠佳组(n=34);同时对血运重建欠佳组以1:2匹配,选取同年龄的68例经髋关节液穿刺的髋关节滑膜炎患儿为对照组。另收集2024年6月-2025年1月于该院就诊的82例Perthes病患儿作为验证集用于列线图模型的验证。比较3组患儿关节液内VEGF、IGF-1及TGF-β_(1)水平,经单因素及分层分析控制混杂偏倚,二元logistic回归分析影响患者血运重建效果的独立危险因素,采用R软件绘制预测血运重建效果的列线图模型并进行验证。结果血运重建欠佳组患儿关节液中VEGF、IGF-1、TGF-β_(1)水平均高于对照组和血运重建良好组(P<0.05)。3类重建手术后血运重建欠佳患儿关节液中VEGF、IGF-1及TGF-β_(1)水平均高于血运重建良好者(P<0.05);但不同手术类型的上述3项指标比较,差异无统计学意义(P>0.05)。二元logistic回归分析结果显示,关节液中VEGF、IGF-1、TGF-β_(1)水平是Perthes病患儿术后血运重建欠佳的独立危险因素(P<0.05);据此建立的列线图模型预测Perthes病患儿术后血运重建欠佳的ROC曲线下面积为0.875(95%CI 0.805~0.945),敏感度和特异度分别为0.874、0.851,且校准曲线和决策曲线分析(DCA)提示该模型的临床适用性良好。结论关节液VEGF、IGF-1、TGF-β_(1)水平升高与Perthes病患儿术后血运重建效果不佳有关。这3种因子有望成为Perthes病患儿的预后评估指标。
Objective To explore the relationship between levels of vascular endothelial growth factor(VEGF),insulin-like growth factor 1(IGF-1),and transforming growth factor-β_(1)(TGF-β_(1))in the synovial fluid of children with avascular necrosis of the femoral head(also known as Perthes disease)and the efficacy of postoperative revascularization,aiming to provide a basis for subsequent diagnosis and treatment.Methods A retrospective study was conducted on 262 children with Perthes disease admitted to the Affiliated Hospital of Gansu University of Chinese Medicine from January 2023 to June 2024.Based on postoperative revascularization efficacy,patients were divided into good revascularization group(n=228)and poor revascularization group(n=34).For poor revascularization group,a 1:2 matched case-control design was used to select 68 age-matched children with hip synovitis who underwent hip joint fluid puncture as control group.Additionally,82 children with Perthes disease treated at the hospital from June 2024 to January 2025 were enrolled as a validation cohort for nomogram model verification.The expression levels of VEGF,IGF-1 and TGF-β_(1) in the synovial fluid of three groups were compared.Confounding biases were controlled through univariate and stratified analyses.Binary logistic regression analysis was used to identify independent factors affecting the revascularization effect.R software was utilized to draw and verify the nomogram model for predicting the postoperative revascularization effect.Results The levels of VEGF,IGF-1 and TGF-β_(1) in the synovial fluid of children in poor revascularization group were all higher than those in control group and good revascularization group(P<0.05).After three types of reconstructive surgeries,the levels of VEGF,IGF-1 and TGF-β_(1) in the synovial fluid of children with poor revascularization were all higher than those in children with good revascularization(P<0.05);however,there was no statistically significant difference in the above indicators among different surgical types(P>0.05).Binary logistic regression analysis showed that the levels of VEGF,IGF-1,and TGF-β_(1) in the synovial fluid were independent risk factors for poor postoperative revascularization in children with Perthes disease.The area under the ROC curve of the nomogram model established accordingly for predicting poor postoperative revascularization in children with Perthes disease was 0.875(95%CI 0.805-0.945),with a sensitivity of 0.874 and a specificity of 0.851.Moreover,the calibration curve and decision curve analysis(DCA)indicated that the model had good clinical applicability.Conclusions The increased levels of VEGF,IGF-1 and TGF-β_(1) in synovial fluid are associated with poor postoperative revascularization in children with Perthes disease.These three factors are expected to become prognostic indicators for children with Perthes disease.