骨硬化蛋白和骨形成蛋白-4在诊断异位骨化中的临床意义  

The clinical significance of osteosclerosis protein and bone morphogenetic protein-4 in diagnosis of ectopic ossification

作　　者：赵航[1] 肖海军[1] ZHAO Hang;XIAO Haijun(Department of Orthopaedics,South Branch of Shanghai Sixth People's Hospital/Fengxian District Central Hospital,Shanghai 201400,China)

机构地区：[1]上海市第六人民医院南院/奉贤区中心医院骨科,201400

出　　处：《河北医药》2019年第3期396-399,共4页Hebei Medical Journal

基　　金：上海市科学技术委员会基金资助(编号:15411970900);上海卫生和计划生育委员会(编号:201840135)

摘　　要：目的观察骨硬化蛋白和骨形成蛋白-4在诊断外伤患者异位骨化中的临床意义。方法选择2015年1月至2017年6月就诊的外伤患者104例,按照受伤类型分为单纯脑外伤组(41例),脑外伤合并四肢骨折组(28例)和单纯四肢骨折组(35例)。根据骨折是否异位骨化分为异位骨化组(12例)和非异位骨化组(92例)。观察各组在不同时间点的硬化蛋白和骨形成蛋白-4水平的变化,与是否骨化之间的关系,两指标之间的相关性,两指标在诊断异位骨化的灵敏度和特异性。结果脑外伤合并四肢骨折和单纯四肢骨折患者血清骨硬化蛋白水平明显高于单纯脑外伤组(P <0. 01),而单纯四肢骨折组骨硬化蛋白水平明显高于脑外伤合并四肢骨折组(P <0. 01),骨硬化蛋白水平异位骨化组明显低于无异位骨化组(P <0. 01),3 d、15 d和30 d间比较,15 d水平最高(P <0. 01);脑外伤合并四肢骨折和单纯四肢骨折患者血清骨形成蛋白-4明显低于单纯脑外伤组(P <0. 01),而单纯四肢骨折组明显低于脑外伤合并四肢骨折组(P <0. 01),骨形成蛋白-4异位骨化组明显高于无异位骨化组(P <0. 01),在3 d、15 d和30 d间比较,15 d水平最高(P <0. 01)。伤后15 d血清骨硬化蛋白与骨形成蛋白-4之间呈负相关(r=-0. 509,P <0. 01)。伤后15 d骨硬化蛋白的最佳截断值为179. 49 ng/L,灵敏度为100%,特异性为90. 20%,AUC为0. 976;骨形成蛋白的最佳截距为273. 69 ng/L,灵敏度为100%,特异性为98. 91%,AUC为0. 998。两指标在诊断骨异位骨化形成方面差异无统计学意义(P> 0. 05)。结论骨硬化蛋白和骨形成蛋白-4在诊断异位骨化具有较高的特异性和灵敏度,值得在临床推广。Objective To investigate the clinical significance of osteosclerosis protein and bone morphogenetic protein-4 in diagnosis of ectopic ossification in patients with trauma.Methods A total of 104 patients with trauma who were treated in our hospital from January 2015 to December 2016 were enrolled in the study.According to trauma type,these patients were divided into simple brain trauma group(n=41),brain trauma with limb fracture group(n=28)and simple limb fracture group(n=35).moreover,according to ectopic ossification of bone fracture,these patients were divided into heterotopic ossification group(n=12)and non heterotopic ossification group(n=92).The changes of levels of osteosclerosis protein and bone morphogenetic protein-4 in different time points were observed in each group,and their relationship with or without ossification,and the correlation between the two indexes were analyzed.Moreover the sensitivity and specificity of the two indexes in diagnosis of heterotopic ossification were evaluated.Results The serum levels of osteosclerosis protein in brain trauma with limb fracture group and simple limb fracture group were significantly higher than those in simple brain trauma group(P<0.01),which in simple limb fracture group were significantly higher than those in brain trauma with limb fracture group(P<0.01).Moreover the serum levels of osteosclerosis protein in heterotopic ossification group were significantly lower than those in non heterotopic ossification group(P<0.01),which were the highest at 15d among 3d,15d and 30d(P<0.01).The serum levels of bone morphogenetic protein-4 in brain trauma with limb fracture group and simple limb fracture group were significantly lower than those in simple brain trauma group(P<0.01),moreover,which in simple limb fracture group were significantly lower than those in brain trauma with limb fracture group(P<0.01).In addition the serum levels of bone morphogenetic protein-4 in heterotopic ossification group were significantly higher than those in non heterotopic ossification

关 键 词：异位骨化 骨硬化蛋白 骨形成蛋白-4 外伤 骨折 

分 类 号：R68[医药卫生—骨科学]