脊髓损伤后神经源性异位骨化的危险因素分析

Risk factors for neurogenic heterotopic ossification after spinal cord injury

目的分析脊髓损伤后发生神经源性异位骨化(neurogenic heterotopic ossification,NHO)的相关危险因素。方法前瞻性采集并分析2008年1月至2014年1月符合纳入标准的脊髓损伤致截瘫患者150例,利用高频超声检查髋关节是否出现NHO,将患者分为NHO组和非NHO组。记录并比较两组患者的年龄、性别、痉挛、压疮、血浆α2-HS糖蛋白、血清骨成型蛋白、血清D-二聚体、血清C-反应蛋白及血清钙离子含量、脊髓损伤节段及程度。采用多因素Logistic回归分析脊髓损伤后发生NHO的相关危险因素。结果 56例(37.33%)患者发生NHO。单因素分析示,两组间年龄、血浆α2-HS糖蛋白、血清骨成型蛋白、血清D-二聚体、血清C-反应蛋白、血清钙离子水平、压疮和脊髓损伤程度差异有统计学意义。多因素Logistic回归分析结果发现:NHO组患者的α2-HSG浓度较非NHO组显著降低,OR值为0.929(95%CI:0.887,0.973)。结论脊髓损伤患者血浆α2-HSG浓度下降是发生NHO的独立危险因素。血浆α2-HSG浓度越低,越易发生NHO。

Objective To explore the risk factors for the occurrence of neurogenic heterotopic ossification （NHO） after spinal cord injury （SCI）. Methods From January 2008 to January 2014, 150 paraplegic patients after SCI were included in a prospective study. According to the results of high-frequency ultrasound on the bilateral hip joint, the enrolled patients were divided into group NHO and group without NHO. Age, gender, α2-heremans-schmid glycoprotein （α2-HSG）, bone morphogenetic proteins （BMP）, D-dimmer （DD）, C-reactive protein （CRP）, calcium ion, spasm and pressure sores, degree and segment of spinal cord injury were compared between the two groups. Multi-factor Logistic regression analysis was applied to investigate risk factors for NHO after SCI. Results NHO were detected in 56 patients. Results of single factor analysis showed that differences between the two groups in age,α2-HSG level, BMP level, DD level, CRP level, calcium ion level, pressure ulcer ratio and damage degree were all significant. Multi-factor Logistic regression analysis found that the level ofα2-HSG in NHO group were significantly lower than those in non NHO group, and the OR value was 0.929 （95%CI：0.887, 0.973）. Conclusion The level ofα2-HSG in patients after spinal cord injury is an independent risk factor for the occurrence of NHO. The lower level ofα2-HSG, the higher risk of NHO in patients after SCI.