解放军医学杂志2025，Vol.50Issue(10)：1263-1269,7.DOI:10.11855/j.issn.0577-7402.1749.2025.0716
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-β1水平的关系
Relationship between postoperative revascularization efficacy and levels of VEGF,IGF-1 and TGF-β1 in joint synovial fluid in children with Perthes Disease
摘要
Abstract
Objective To explore the relationship between levels of vascular endothelial growth factor(VEGF),insulin-like growth factor 1(IGF-1),and transforming growth factor-β1(TGF-β1)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-β1 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-β1 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-β1 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-β1 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-β1 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.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-β1/血运重建Key words
ischemic necrosis of femoral head/vascular endothelial growth factor/insulin-like growth factor 1/transforming growth factor-β1/revascularization分类
医药卫生引用本文复制引用
梁恬,张琪,马利海,郎爱强,姚川江,徐兰萍..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-β1水平的关系[J].解放军医学杂志,2025,50(10):1263-1269,7.基金项目
This work was supported by the Natural Science Foundation of Gansu Province(23JRRA1205)甘肃省自然科学基金(23JRRA1205) （23JRRA1205）
