创伤性脊柱骨折合并脊髓损伤患者血清pNF-H动态变化及其与脊髓损伤程度的相关性

Dynamic changes of serum pNF-H in patients with traumatic spinal fracture and spinal cord injury and its correlation with the degree of spinal cord injury

目的探讨创伤性脊柱骨折合并脊髓损伤患者血清磷酸化高分子量神经微丝蛋白(pNF-H)动态变化与脊髓损伤程度的相关性。方法回顾性分析2017年1月—2019年1月平煤神马医疗集团总医院脊柱外科收治的创伤性脊柱骨折患者94例,其中合并脊髓损伤48例(脊髓损伤组),男性35例,女性13例;年龄18~60岁,平均50.7岁;致伤原因道路交通伤20例,摔伤16例,高处坠落伤7例,砸伤5例。单纯脊柱骨折46例(单纯骨折组),男性30例,女性16例;年龄18~60岁,平均50.8岁;致伤原因道路交通伤18例,摔伤13例,高处坠落伤8例,砸伤7例。选取同期笔者医院进行体检的健康者40例作为健康对照组,男性30例,女性10例;年龄18~60岁,平均50.8岁。比较各组间伤后12h、24h、3d、7d、14d血清pNF-H浓度变化;并分析脊髓损伤组不同美国脊髓损伤协会(ASIA)神经功能分级患者12h、24h、3d、7d、14d时血清pNF-H浓度变化,采用Spearman检验分析血清pNF-H动态变化与ASIA神经功能分级的相关性。结果伤后12h、24h、3d、7d、14d,脊髓损伤组血清pNF-H浓度高于相应时间点单纯骨折组、健康对照组(P<0.05),单纯骨折组血清pNF-H浓度高于相应时间点健康对照组(P<0.05)。不同ASIA分级患者不同时间点血清pNF-H浓度比较差异有统计学意义(P<0.05);在12h、24h、3d、7d、14d时A级患者血清pNF-H浓度高于B、C、D级(P<0.05),B级患者血清pNF-H浓度高于C、D级(P<0.05),C级患者血清pNF-H浓度高于D级(P<0.05);血清pNF-H与ASIA分级存在负相关(r=-0.951,P<0.05)。结论创伤性脊柱骨折合并脊髓损伤患者血清pNF-H浓度随时间变化,而ASIA分级越严重血清pNF-H浓度越高。

Objective To explore the dynamic changes of serum phosphorylated high molecular weight neurofilament(pNF-H)in patients with traumatic spinal fracture and spinal cord injury and its correlation with the degree of spinal cord injury.Methods A total of 94 patients with traumatic spinal fractures treated in our hospital from Jan.2017 to Jan.2019 were retrospectively analyzed,including 48 patients with combined spinal cord injury(spinal injury group,male:35,female:13;traffic accidents:20,falling:16,high falling:7,crushing:5;age:18-60 years,mean age:50.7 years)and 46 patients with spinal fractures alone(simple fracture group,male:30,female:16;traffic accidents:18,falling:13,high falling:8,crushing:7;age:18-60 years,mean age:50.8 years).Meanwhile,40 healthy people(male:30,female:10,age:18-60 years,mean age:50.8 years)undergoing physical examination in the hospital were used as the control group.Serum pNF-H was measured to compare the changes in serum pNF-H concentration at 12 hours,24 hours,3 days,7 days,and 14 days after injury in those groups.The serum pNF-H concentration changes in patients with different American Spinal Cord Injury Association(ASIA)scores at 12 hours,24 hours,3 days,7 days,and 14 days were also analyzed.The correlation between the dynamic changes of serum pNF-H and ASLA grades was analyzed using Spearman test.Results The serum pNF-H concentration in the spinal injury group at 12 hours,24 hours,3 days,7 days,and 14 days was higher than that in the simple fracture group and the control group(P<0.05).The pNF-H concentration was higher in simple fracture group than in control group(P<0.05).The serum pNF-H concentration of patients with different ASIA grades at different time points was statistically different(P<0.05).At 12 hours,24 hours,3 days,7 days,and 14 days,the grade A serum pHF-H concentration was higher than that of grades B,C,and D(P<0.05);the grade B was higher than grades C and D(P<0.05);and the grade C was higher than grade D(P<0.05).There was a negative correlation between serum pNF-H and ASIA grades(r=-0.951,P<0.05).Conclusion Serum pNF-H concentration changes over time in patients with traumatic spinal fracture and spinal cord injury,and the more severe ASIA classification,the higher the serum pNF-H concentration.