血清神经突起因子和转化生长因子-β1对脊柱骨折合并脊髓损伤患者神经功能恢复的预测作用  

Value of serum neuritin and transforming growth factor-β1 in predicting neurological rehabilitation in patients with spinal fracture and spinal cord injury

作　　者：王玉波[1] 田文龙 朱涛[1] 葛波涌[1] Wang Yubo;Tian Wenlong;Zhu Tao;Ge Boyong(Department of Emergency,Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,China)

机构地区：[1]郑州大学第二附属医院急诊科,郑州450000

出　　处：《脊柱外科杂志》2023年第5期326-330,共5页Journal of Spinal Surgery

基　　金：河南省医学科技攻关计划项目(201702075)。

摘　　要：目的探讨入院时血清神经突起因子、转化生长因子-β1(TGF-β1)水平对脊柱骨折合并脊髓损伤患者术后神经功能恢复情况的预测价值。方法纳入2018年2月—2019年3月收治的84例单节段脊柱骨折合并脊髓损伤患者为研究对象。采用美国脊髓损伤协会(ASIA)分级评估患者神经功能恢复情况,将术后末次随访时ASIA分级较治疗前提高者归入恢复良好组(n=50),无变化或降低者归入恢复较差组(n=34),比较2组患者入院时基线资料与实验室指标水平,采用logistic回归方法和受试者工作特征(ROC)曲线分析入院时血清神经突起因子、TGF-β1水平与神经功能恢复情况的关系。结果2组性别、年龄、体质量指数(BMI)、骨折节段、脊髓损伤节段、受伤原因、骨折AO分型、脊髓损伤时间、Ogawa创伤指数等基线资料差异无统计学意义(P>0.05)。恢复较差组患者术前血清神经突起因子水平、TGF-β1水平低于恢复良好组,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,入院时血清神经突起因子、TGF-β1水平低可能是脊柱骨折合并脊髓损伤患者术后神经功能恢复较差的危险因素(比值比=1.253,95%置信区间为1.130~1.389,P<0.05;比值比=1.167,95%置信区间为1.088~1.252,P<0.05);绘制ROC曲线发现,入院时血清神经突起因子、TGF-β1水平单独及联合预测脊柱骨折合并脊髓损伤患者术后神经功能恢复的曲线下面积分别为0.844、0.809、0.908,两者联合应用时预测效果最佳。结论脊柱骨折合并脊髓损伤患者入院时血清神经突起因子、TGF-β1水平与术后神经功能恢复情况有关,入院时血清神经突起因子、TGF-β1水平低可能预示患者术后神经功能恢复较差。Objective To investigate the predictive value of the expressions of serum neuritin and transforming growth factor-β1(TGF-β1)for postoperative rehabilitation of neurological function in patients with spinal fracture combined with spinal cord injury.Methods From February 2018 to March 2019,84 patients with single-segment spinal fractures and spinal cord injuries include served as the study subjects.The recovery of neurological function of patients was assessed by the American Spinal Injury Association(ASIA)classification.Those who had improved the ASIA classification at the final follow-up were classified into the good-rehabilitation group(n=50),and those who had not changed or decreased were classified into the poor-rehabilitation group(n=34).The baseline data and laboratory index levels of patients in the 2 groups at admission were compared.Logistic regression method and receiver operating characteristic(ROC)curve were used to analyze the relationship between the levels of serum neuritin and TGF-β1 and the neurological function rehabilitation.Results There was no statistically significant difference in the gender,age,body mass index(BMI),fracture segment,spinal cord injury segment,injury cause,AO classification of spinal fracture,time of spinal cord injury,and Ogawa trauma index between the poor-rehabilitation group and the good-rehabilitation group(P>0.05).The serum levels of neuritin and TGF-β1 in the poor-rehabilitation group were lower than those in the good-rehabilitation group,all with a statistical significance(P<0.05).The results of regression analysis showed that the low expression of serum neuritin and TGF-β1 at admission might be the risk factors of poor neurological rehabilitation in patients with spinal fracture combined with spinal cord injury(odds ratio=1.253,95%confidence interval 1.130-1.389,P<0.05;odds ratio=1.167,95%confidence interval 1.088-1.252,P<0.05).The ROC curve showed that the area under the curve of the serum neuritin and TGF-β1 at admission level in single and combined predictin

关 键 词：脊柱骨折 脊髓损伤 神经肽 转化生长因子Β 

分 类 号：R651.21[医药卫生—外科学]