骨折延迟愈合患者血转化生长因子-β1的改变

Alterations in Serum Level of TGF-β1 in Patients with Delayed Fracture Healing

目的 研究骨折延迟愈合患者外周血中转化生长因子（transforming growth factor，TGF）-β1表达水平的变化趋势，并与正常愈合患者进行对比。方法 共60例骨折延迟愈合患者，取其在骨折后1年内不同时间的外周血标本作为实验组；另取60例骨折后正常愈合的患者作为对照组。通过免疫酶标法分别检测骨折后1、2、4、8、12、24、36、48、60周，各组患者外周血中TGF-β1表达水平的变化趋势，并比较实验组与对照组之间的差异。另检测30例骨不连患者在手术前后及最终愈合时，外周血中TGF-β1的水平。结果 骨折2周后，各组患者的外周血TGF-β1水平都有显著升高（P〈0．01）。在2～4周间，实验组患者的TGF-β1水平急剧下降，又回到正常水平；而对照组患者的外周血TGF-β1仍维持在较高的水平，是实验组的1．2倍（P〈0．01）。对照组TGF-β1水平直至骨折后8周时，才回落至正常水平。术前骨不连患者外周血TGF-β1水平与正常人无差异，术后2周TGF-β1水平迅速上升（P〈0．01），维持到4周时逐步下降，直到最终愈合时又回落到正常值。结论 骨折患者外周血TGF-β1水平于较早期下降是骨折延迟愈合的一个重要指标。TGF-β1在骨折愈合过程中起关键作用，骨不连患者术后愈合与外周血TGF-β1也有密切联系。

Objective To determine the alterations in serum level of TGF-β1 from patients with delayed fracture healing in comparison with those from normal healing. Methods All the 60 patients with delayed fracture healing were recruited as exp-imental group（Exp）and their peripheral blood samples were collected over a period of 1 years following a standardized time schedule. Another 60 patients with normal healing were recruited as control group （Ctrl）. The serum levels of TGF-β1 at 1,2,4,8,12,24,36,48,60 weeks after trauma were measured using enzyme immunoassays and compared between the 2 groups. TGF-β1 in 30 patients with nonunion Was assayed pre- ,post-operation and after healing. Results Serum levels of TGF-β1 increased significantly 2 weeks after fracture in both groups （P〈0.01）. During 2 to 4 weeks after trauma,TGF-β1 declined dramatically in Exp group to the reference value ;but it still maintained at a relatively higher level in Ctrl group,about 1.2-fold higher than Exp group（P〈0. 01）. TGF-β1 in Ctrl group did not return to the reference value until 8 weeks after trauma. Pre-operation,TGF-13 1 in the patients with nonunion was similar to normal people. There was a significant increase 2 weeks post-operation（P〈0.01）,and a decrease 4 weeks post-operation. Conclusion Decline of serum concentration of TGF-β1 occurred earlier in patients with delayed fracture healing,which indicated that TGF-β1 plays a critical role in fracture healing. It also seems dependent on sufficient availability of TGF--β1 for patients with nonunion during consolidation phase.