创伤性骨折延迟愈合患者血清骨转化标志物的表达水平及意义

Expression level and significance of serum markers of bone turnover in patients with delayed union of traumatic fracture

目的:探讨创伤性骨折延迟愈合患者血清骨形成标志物骨特异碱性磷酸酶(BSAP)、骨钙素N端中分子片段(N-MID)、1型前胶原氨基末端前肽(P1NP)和骨吸收标志物β-胶原降解产物(β-crosslaps)的表达水平及意义。方法:选取2016年1月至2018年6月本院收治的84例胫骨干骨折延迟愈合患者(延迟愈合组),另选取同期胫骨干骨折正常愈合患者60例(正常愈合组),比较两组骨折后1、4、8、12周时血清BSAP、N-MID、P1NP和β-crosslaps水平。采用Logistic回归分析延迟愈合的影响因素;受试者工作特征(ROC)曲线分析骨转化指标预测骨折延迟愈合的价值,计算曲线下面积(AUC)。结果:骨折1周时两组血清BSAP、N-MID、P1NP、β-crosslaps水平比较差异无统计学意义(P>0.05)。骨折后4、8和12周时,延迟愈合组血清BSAP、N-MID、P1NP水平均低于正常愈合组(P<0.05),两组血清β-crosslaps水平的比较差异无统计学意义(P>0.05)。术后感染,骨折后4周血清BSAP、N-MID和P1NP表达水平是影响骨折延迟愈合的独立因素(P<0.05)。骨折后4周血清P1NP、BSAP、N-MID预测延迟愈合的AUC分别为0.897、0.843、0.790,三者联合检测可将AUC提高至0.916。结论:血清BSAP、N-MID、P1NP水平对早期预测创伤性胫骨干骨折延迟愈合有一定价值。

Objective:To investigate the expression and value of bone specific alkaline phosphatase(BSAP),N-MID osteocalcin(N-MID),N-propeptide of type 1 collagen(P1NP),β-crosslaps in patients with delayed union of traumatic fracture.Methods:From January 2016 to June 2018,84 cases of delayed union of tibial shaft fracture(delayed union group)and 60 patients with normal healing of tibial shaft fractures(normal union group)were selected.The levels of BSAP,N-MID,P1NP andβ-crosslaps were compared between the two groups at 1,4,8 and 12 weeks after fracture.Logistic regression was used to analyze the influencing factors of delayed union.ROC curve was used to analyze the value of bone turnover index in predicting delayed union,and AUC was calculated.Results:There was no significant difference in serum BSAP,N-MID,P1NP andβ-crosslaps between the two groups at 1 week after fracture(P>0.05).The serum levels of BSAP,N-MID,P1NP in the delayed union group were lower than those in the normal union group at 4,8 and 12 weeks after fracture(P<0.05).There was no significant difference inβ-crosslaps levels between the two groups at different time points(P>0.05).Postoperative infection and the expression levels of BSAP,N-MID and P1NP at 4 weeks after fracture were independent factors affecting delayed fracture union(P<0.05).The AUC of serum P1NP,BSAP,N-MID predicting delayed union at 4 weeks after fracture were 0.897,0.843,0.790 respectively,combined detection could increase the AUC to 0.916.Conclusion:Serum levels of BSAP,N-MID and P1NP have certain value in early prediction of delayed union of traumatic tibial shaft fractures.