胸椎压缩性骨折伴脊髓损伤患者血清Fbg TNF-αNeuritin水平与神经功能的关系

The relationship between serum Fbg,TNF-αand Neuritin levels and neurological function in patients with thoracic spine compression fracture and spinal cord injury

目的探讨胸椎压缩性骨折伴脊髓损伤(SCI)患者血清纤维蛋白原(Fbg)、肿瘤坏死因子(TNF-α)、神经突起因子(Neuritin)水平与神经功能的关系。方法选取2015-01—2019-06河南医学高等专科学校附属医院骨科收治的胸椎压缩性骨折伴脊髓损伤患者90例,按患者脊髓损伤程度分为完全SCI组28例和不完全SCI组62例,其中ASIA分级A级28例,B级33例,C级18例,D级11例。根据患者预后分为预后良好组51例和预后不良组38例。选取同期单纯胸椎压缩性骨折患者30例纳入单纯骨折组,选取同期健康体检正常人群30例作为正常对照组。所有患者于伤后24 h检测Fbg、TNF-α、Neuritin水平。结果完全SCI组、不完全SCI组、单纯骨折组3组患者的Fbg、TNF-α、Neuritin水平均高于正常对照组(P<0.05)。单纯骨折组的Fbg水平高于完全SCI组和不完全SCI组(P<0.05)。单纯骨折组的TNF-α和Neuritin水平低于完全SCI组和不完全SCI组(P<0.05)。随着患者的神经功能损伤严重程度逐渐加重,Fbg水平逐渐下降(P<0.05),TNF-α和Neuritin水平逐渐上升(P<0.05)。Fbg水平与脊髓损伤神经功能分级呈负相关(r=-0.420,P<0.001),TNF-α、Neuritin水平与脊髓损伤神经功能分级呈正相关(r=0.313,P<0.001;r=0.694,P<0.001)。预后良好组的Fbg水平高于预后不良组(P<0.05)。预后良好组的TNF-α和Neuritin水平低于预后不良组(P<0.05)。Fbg、TNF-α、Neuritin预测患者神经功能损伤严重程度的最佳阈值分别为287.83mg/dL(AUC=0.780)、2.06 ng/mL(AUC=0.732)、56.70 pg/L(AUC=0.781)。Fbg、TNF-α、Neuritin预测患者不良预后的最佳阈值分别为293.14 mg/dL(AUC=0.690)、1.91 ng/mL(AUC=0.713)、59.37 pg/L(AUC=0.698)。结论胸椎压缩性骨折伴脊髓损伤患者的血清Fbg、TNF-α、Neuritin水平与神经功能具有相关性,可在一定程度上预测患者的神经功能损伤严重程度和预后情况。

Objective To investigate the relationship between serum fibrinogen(Fbg),tumor necrosis factor(TNF-α)and Neuritin levels in patients with thoracic spine compression fracture and spinal cord injury(SCI).Methods Ninety patients with thoracic spine compression fracture and SCI who were admitted to the hospital from January 2015 to June 2019 were selected.According to the degree of SCI,the patients were divided into 28 cases in complete SCI group and 62 patients in incomplete SCI group.There were 28 cases of ASIA grade A,33 cases of grade B,18 cases of grade C and 11 cases of grade D.According to the prognosis,the patients were divided into 51 patients with good prognosis and 38 patients with poor prognosis.Thirty patients with simple thoracic spine compression fracture were selected as the simple fracture group,and 30 healthy people who received physical examination in the same period were selected as the normal control group.Levels of Fbg,TNF-α,and Neuritin in all patients were detected at 24 h after injury.Results The levels of Fbg,TNF-αand Neuritin in the complete SCI group,incomplete SCI group and simple fracture group were higher than those in the normal control group(P<0.05).The Fbg level in simple fracture group was higher than that in the complete SCI group or the incomplete SCI group(P<0.05).The levels of TNF-αand Neuritin in the simple fracture group were lower than those in the complete SCI group and the incomplete SCI group(P<0.05).With the aggravation of neurological impairment,Fbg level decreased gradually(P<0.05),and levels of TNF-αand Neuritin gradually increased(P<0.05).The level of Fbg was negatively correlated with the grade of neurological function of SCI(r=-0.420,P<0.001).The levels of TNF-αand Neuritin were positively correlated with the grade of neurological function(r=0.313,P<0.001;r=0.694,P<0.001).The Fbg level in the good prognosis group was higher than that in the poor prognosis group(P<0.05).The levels of TNF-αand Neuritin in the good prognosis group were lower than those in the poor prognosis group(P<0.05).The optimal thresholds of Fbg,TNF-α,and Neuritin for predicting the severity of neurological impairment were 287.83 mg/dL(AUC=0.780),2.06 ng/mL(AUC=0.732)and 56.70 pg/L(AUC=0.781),respectively.The optimal thresholds for predicting poor prognosis were 293.14 mg/dL(AUC=0.690),1.91 ng/mL(AUC=0.713)and 59.37 pg/L(AUC=0.698),respectively.Conclusion The levels of serum Fbg,TNF-αand Neuritin in patients with thoracic spine compression fracture and SCI are correlated with neurological function.They can be used to predict the severity of neurological impairment and the prognosis of patients.