脊柱骨折伴急性脊髓损伤NOD样受体蛋白3炎症小体及相关因子变化及其与预后的相关性  

Changes and clinical significance of NLRP3 inflammasomes and related factors in patients with spinal fracture complicated with acute spinal cord injury

作　　者：杜媛媛 杨好 陈程程 何紫艳 DU Yuan-yuan;YANG Hao;CHEN Cheng-cheng;HE Zi-yan(Department of Rehabilitation Medicine,the 901st Hospital of the Joint Logistics Support Force of PLA,Hefei 230000,Anhui,China)

机构地区：[1]中国人民解放军联勤保障部队第九O一医院康复医学科,安徽合肥230000

出　　处：《中国骨伤》2024年第7期684-688,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:研究脊柱骨折伴急性脊髓损伤(spinal cord injury,SCI)患者NOD样受体蛋白3(NOD like receptor protein 3,NLRP3)炎症小体及相关因子与预后的相关性。方法:选择2019年6月至2022年3月收治的86例脊柱骨折伴急性SCI患者作为SCI组,其中男48例,女38例,年龄33~56(43.48±6.58)岁;同期体检的100例健康志愿者作为对照组,男56例,女44例,年龄34~53(45.13±6.43)岁。收集外周血单个核细胞(peripheral blood mononuclear cell,PBMC)并检测NLRP3、半胱氨酸蛋白酶-1(cysteinyl aspartate specific proteinase-1,Caspase-1)的mRNA表达,收集血清并检测白细胞介素-1β(interleukin,IL-1β)、IL-18的水平。根据Frankel分级将SCI组分为完全损伤患者和不完全损伤患者,根据日本矫形外科学会(Japanese Orthopaedic Association,JOA)评分将SCI组分为预后良好组和预后不良组。比较各组间NLRP3、Caspase-1、IL-1β、IL-18的差异,采用Logistic回归分析SCI组患者预后不良的影响因素。结果:SCI组及对照组的PBMC中NLRP3 mRNA[(1.41±0.33)vs(1.00±0.19)]、Caspase-1 mRNA[(1.44±0.35)vs(1.00±0.16)]表达水平及血清中IL-1β[(45.34±13.22)pg·ml^(-1) vs(16.58±4.24)pg·ml^(-1)]、IL-18含量[(40.95±8.77)pg·ml^(-1) vs(12.57±3.68)pg·ml^(-1)],SCI组均高于对照组(P<0.05)。SCI组中完全损伤患者的PBMC中NLRP3 mRNA(1.63±0.34)、Caspase-1 mRNA(1.67±0.27)表达水平及血清IL-1β(51.09±11.10)pg·ml^(-1)、IL-18(47.65±7.93)pg·ml^(-1)高于不完全损伤患者[(1.31±0.27)、(1.34±0.33)、(42.85±13.36)、(38.05±7.48)pg·ml^(-1)](P<0.05);SCI组中预后不良患者的NLRP3 mRNA(1.66±0.31)、Caspase-1 mRNA(1.72±0.31)、血清IL-1β(51.21±11.31)pg·ml^(-1)、IL-18(45.70±7.25)pg·ml^(-1)、完全损伤(21例)、脊髓水肿或出血(15例)高于预后良好患者[(1.28±0.26)、(1.37±0.36)、(42.79±13.25)pg·ml^(-1)、(38.90±8.63)pg·ml^(-1)、5例、20例],(P<0.05);完全损伤、PBMC中NLRP3 mRNA表达是SCI组预后不良的影响因素(P<0.05)。结论:脊柱骨折合�Objective To investigate the changes and clinical significance of NOD like receptor protein 3(NLRP3)inflammasomes and related factors in patients with spinal fractures complicated with acute spinal cord injury(SCI).Methods Eighty-six spinal fracture patients complicated with acute SCI admitted to hospital from June 2019 to March 2022 were selected as SCI group,There were 48 males and 38 females,with an average age of(43.48±6.58)years old.And 100 healthy volunteers who underwent physical examination during the same time were selected as control group,including 56 males patients and 44 females patients,with an average age of(45.13±6.43)years old.Peripheral blood mononuclear cell(PBMC)were collected,and the mRNA expressions of NLRP3 and Caspase-1 were detected.Serum was collected and the levels of interleukin(IL)-1β,IL-18 were detected.According to Frankel's grade,the SCI group was divided into complete injury patients and incomplete injury patients,and according to the Japanese Orthopedic Society(JOA)grade,the SCI group was divided into good prognosis group and poor prognosis group.The difference of NLRP3,Caspase-1,IL-1β,IL-18 among groups were compared,the influencing factors for poor prognosis in SCI patients was analyzed by Logistic regression.Results The mRNA expression levels of NLRP3(1.41±0.33)and Caspase-1(1.44±0.35)in PBMC and the levels of IL-1β(45.34±13.22)pg·ml^(-1),IL-18(40.95±8.77)pg·ml^(-1) in serum of SCI group were higher than those of the control group[(1.00±0.19),(1.00±0.16),(16.58±4.24)pg·ml^(-1),(12.57±3.68)pg·ml^(-1)](P<0.05).The mRNA expression levels of NLRP3(1.63±0.34)and Caspase-1(1.67±0.27)in PBMC and the levels of IL-1β(51.09±11.10)pg·ml^(-1),IL-18(47.65±7.93)pg·ml^(-1) in serum of patients with complete injury in the SCI group were higher than those of patients with incomplete injury[(1.31±0.27),(1.34±0.33),(42.85±13.36)pg·ml^(-1),(38.05±7.48)pg·ml^(-1)](P<0.05).The mRNA expression levels of NLRP3(1.66±0.31)and Caspase-1(1.72±0.31)in PBMC and the levels of

关 键 词：脊柱骨折 急性脊髓损伤 NLRP3炎症小体 白细胞介素 预后 

分 类 号：R683.2[医药卫生—骨科学]