血清NTX、FGF-2、IGF-1及CaM水平预测肱骨干骨折内固定术后骨不愈合的预测价值  

Values of serum levels of NTX,FGF-2,IGF-1 and CaM in predicting bone non-union after internal fixation of humeral shaft fracture

作　　者：周峰 高一淋 谢丁丁 ZHOU Feng;GAO Yilin;XIE Dingding(Department of Orthopaedics,Xuzhou First People′s Hospital,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州市第一人民医院骨科,江苏徐州221000

出　　处：《国际检验医学杂志》2023年第15期1826-1831,1837,共7页International Journal of Laboratory Medicine

基　　金：徐州市卫生健康委科技项目(XWKYHT20200026)。

摘　　要：目的探讨血清Ⅰ型胶原氨基端末肽(NTX)、成纤维细胞生长因子-2(FGF-2)、胰岛素样生长因子-1(IGF-1)及钙调蛋白(CaM)水平对肱骨干骨折内固定术后骨不愈合的预测价值。方法选取2017年1月至2020年7月该院收治的拟行内固定术治疗的114例肱骨干骨折患者作为研究对象,均于术前及术后1周、4周、8周行血清NTX、FGF-2、IGF-1及CaM水平检测。根据随访术后12个月骨愈合情况将患者分为骨愈合组与骨不愈合组,对比一般资料及血清NTX、FGF-2、IGF-1、CaM水平,采用多因素Logistic回归法分析肱骨干骨折内固定术后骨不愈合的影响因素,采用受试者工作特征(ROC)曲线分析上述各指标单项及联合对内固定术后骨不愈合的预测价值。结果骨不愈合组高能量损伤占比高于骨愈合组,骨不愈合组解剖复位占比低于骨愈合组,差异有统计学意义(P<0.05)。两组术后1周、4周、8周的血清各指标水平均高于术前,术后4周、8周的血清各指标水平均高于术后1周,差异有统计学意义(P<0.05)。多因素Logistic回归性分析,结果显示高能量损伤是肱骨干骨折内固定术后骨不愈合的危险因素(P<0.05),而解剖复位及术后4周的血清NTX、FGF-2、IGF-1、CaM水平均是肱骨干骨折内固定术后骨愈合的保护因素(P<0.05)。经ROC曲线分析,术后4周血清NTX、FGF-2、IGF-1、CaM水平联合预测肱骨干骨折内固定术后骨不愈合的灵敏度与曲线下面积均高于各指标单独预测(P<0.05)。结论血清NTX、FGF-2、IGF-1、CaM水平均与肱骨干骨折患者内固定术后骨不愈合密切关联,均对其术后骨不愈合具有一定的预测价值,且四项指标联合预测的价值更为良好,可作为早期评估肱骨干骨折内固定术后骨愈合情况的参考指标而指导临床进一步治疗。Objective To investigate the predictive values of serum N-terminal telopeptide of typeⅠcollagen(NTX),fibroblast growth factor-2(FGF-2),insulin-like growth factor-1(IGF-1)and calmodulin(CaM)in bone non-union after internal fixation of humeral shaft fracture.Methods 114 cases of humeral shaft fractures treated by internal fixation in a hospital from January 2017 to July 2020 were selected as the study objects,and the levels of serum NTX,FGF-2,IGF-1 and CaM were detected before operation and 1 week,4 weeks and 8 weeks after operation.Followed up for 12 months after operation,the patients were divided into bone union group and bone non-union group according to the bone healing,and the general data and the levels of serum NTX,FGF-2,IGF-1 and CaM were compared,and the influencing factor of bone non-union after internal fixation of humeral shaft fracture was analyzed by multivariate Logistic regression method,and the predictive values of single and combined detection of the above indexes for bone non-union after internal fixation were analyzed by receiver operating characteristic(ROC)curve.Results The proportion of high energy injury in non-union group was higher than that in bone union group,and the proportion of anatomic reduction in non-union group was lower than that in bone union group,with statistical significance(P<0.05).The levels of serum indexes at 1 week,4 weeks and 8 weeks after surgery were higher than those before surgery,and the levels at 4 weeks and 8 weeks after surgery were higher than those at 1 week after surgery,with statistical significance(P<0.05).Multivariate Logistic regression analysis showed that high energy injury was a risk factor for bone non-union after internal fixation of humeral shaft fracture(P<0.05),while anatomical reduction and serum NTX,FGF-2,IGF-1 and CaM levels 4 weeks after surgery were protective factors for bone union after internal fixation of humeral shaft fracture(P<0.05).According to ROC curve analysis,the sensitivity and area under the curve of serum NTX,FGF-2,IGF-1 and

关 键 词：Ⅰ型胶原氨基末端肽 成纤维细胞生长因子-2 胰岛素样生长因子-1 钙调蛋白 肱骨干骨折 

分 类 号：R687.3[医药卫生—骨科学]