TNF-α和Neuritin在四肢骨折合并脊髓损伤患者血清中的表达变化及临床意义

Change of expression of TNF-α and Neuritin in the serum of patients with extremities fracture with spinal cord injury and its clinical significance

目的探讨血清肿瘤坏死因子-α(TNF-α)和神经突起因子(Neuritin)水平在四肢骨折伴脊髓损伤中对骨折愈合的作用。方法选择2016年5月~2017年4月收治的42例单纯骨折患者(单纯骨折组)、26例单纯脊髓损伤患者(单纯脊髓损伤组)、30例四肢骨折合并脊髓损伤患者(四肢骨折合并脊髓损伤组);同期选取48例在体检中心行健康体检的正常人(正常组)。采用酶联免疫吸附(ELISA)技术检测血清TNF-α和Neuritin水平在各病例组术后第3、7、14天的变化情况,同时检测其在正常组中的表达水平。结果术后不同时间段,单纯骨折组、单纯脊髓损伤组、四肢骨折合并脊髓损伤组血清TNF-α、Neuritin含量呈动态表达现象,且均高于正常组,其中以四肢骨折合并脊髓损伤组变化最大,其TNF-α、Neuritin变化幅度明显高于其他三组,差异有统计学意义(P<0.01)。结论四肢骨折合并脊髓损伤患者外周血中TNF-α与Neuritin含量变化情况明显高于其余三组,表明与创伤骨折的修复存在密切关联,这两种因子可能在骨折愈合过程中共同发挥作用,故推断其可能是脊髓损伤后加速骨折愈合的关键因子。

Objective To investigate the role of serum tumor necrosis ihctor-α （TNF-α） and neufite factor （Neuritin） in the healing of extremities fracture with spinal cord injury.Methods From May 2016 to April 2017,42 patients with simple fractures（ simple fracture group）, 26 patients with simple spinal cord injury （simple spinal cord injury group）, and 30 patients with extremities fracture with spinal cord injury （extremities fracture with spinal cord injury group） were selected for this study.During the same period,48 normal persons who underwent physical examination in physical examination center were also selected（ normal group）.The levels of serum TNF-α and Neuritin were detected by immunoassay （ELISA） on the 3rd,7th and 14th day after operation in each case group,and their expression levels in the normal group were detected at the same time.Results At different time after operation,the serum TNF-α and Neuritin levels in the simple fracture group, the simple spinal cord injury group and the extremity fracture with spinal cord injury group showed dynamic expression, and were higher than those in the normal group. Among them, serum TNF-α and Neufitin levels in the extremity fracture with spinal cord injury group had the largest change, and the changes were significantly higher than those of the other three groups, so difference was staistically significant（P〈0.01）.Conclusion The changes of sreum TNF-α and Neuritin in patients with extremity fracture with spinal injury are significantly higher than those in the other three groups,which are closely related to the healing of traumaic fractures.These two factor may play a joint role in the process of fracyure healing,so it is inferred that they may be the key factors to accelerate fracture healing after apinal cord injury.