骨成型蛋白-7在外伤患者异位骨化形成中的作用

Association between serum BMP-7 and heterotopic ossification in patients with traumatic brain injuries and limb fractures

目的探讨脑外伤和四肢骨折患者血清骨成型蛋白-7(BMP-7)在异位骨化发生中的作用。方法选择2007年12月至2009年1月入院的外伤患者145例,按骨折类型分为单纯脑外伤组57例、单纯四肢骨折组48例、脑外伤合并四肢骨折组40例,然后按14~16个月后髋、肩、肘、膝关节部位X线平扫是否存在异位骨化分为可见异位骨化组17例和未见异位骨化组128例。145例患者在骨折发生后0.5 d、3 d、15 d、30 d分别抽取外周静脉血,选择49例健康体检者作为对照组,用酶联免疫吸附法检测其血清中BMP-7蛋白的含量。结果 21.05%的单纯脑外伤患者和41.7%的单纯四肢骨折患者发生异位骨化差异有统计学意义(χ2=5.05,P<0.05)。伤后3 d、15 d、30 d三种骨折类型患者血清BMP-7水平差异有统计学意义(P<0.01或0.05);异位骨化组和无异位骨化组比较,伤后15d、30d患者血清BMP-7水平差异有统计学意义(P<0.01)。患者组与健康组比较,其血清BMP-7水平差异有统计学意义(P<0.01或0.05)。伤后患者血清BMP-7水平随病程推移而增高(P<0.05)。结论单纯脑外伤患者血清高浓度BMP-7是异位骨化的因素之一,其3d^30d时间点的浓度可以作为预防异位骨化的观察指标。

Objective To investigate the relationship between serum bone morphogenetic proteins-7（BMP-7） and heterotopic ossification（HO） in patients with traumatic brain injuries（TBI） and limb fractures.Methods From December 2007 to January 2009,145 patients with TBI or limb fractures were selected for the study.Based on the types of injuries,patients were divided into group A（57 patients with TBI only）,group B（48 patients with limb fractures only） and group C（40 patients with TBI and limb fractures）.A group of 17 patients developed HO while the other 128 patients were HO-free by X-ray diagnosis in 14~16 months later.The serum concentrations of BMP-7 were measured by enzyme linked immunosorbent assay（ELISA） at 12 hours and on day 3,15 and 30 after the injuries/fractures.Reference range of BMP-7 was determined by the serum BMP-7 of 49 healthy teachers.Results The incidence rate of HO was significantly higher in group A（21.05%,12/57） than in group B（4.17%,2/48）（χ2=5.05,P0.05）.There were significant differences in the serum concentrations of BMP-7 on day 3,15 and 30 after the injuries/fractures among the three groups（P0.01 or 0.05）.Patients with HO development had significantly higher concentrations of serum BMP-7 on day 15 and 30 on average than patients without HO development did（P0.01）.The peak levels of BMP-7 were observed between 3 and 15 days after the injuries.The concentrations of serum BMP-7 between day 3 and 30 after injuries were significant higher in the patients than in healthy controls on average（P0.01）.Conclusion The high level of serum BMP-7 between day 3 and 30 after traumatic injuries was associated with the development of HO.It might be able to serve as the prognostic indicator of HO development.