骨代谢指标、血钙及25-羟维生素D在脊柱结核伴截瘫患者中的表达及临床意义

Expression and Clinical Significance of Bone Metabolism Indexes,Blood Calcium and 25-hydroxyvitamin D in Patients with Spinal Tuberculosis Combined with Paraplegia

目的:研究骨代谢指标[Ⅰ型胶原羧基末端肽(CTX-Ⅰ)和骨碱性磷酸酶(BAP)]、血钙及25-羟维生素D[25(OH)D]在脊柱结核伴截瘫患者中的表达及临床意义。方法:选取2016年6月—2018年6月于本院接受诊治的84例脊柱结核伴截瘫患者临床资料设为研究组,并选取同期进行健康检查的96例正常人群作为对照组。比较骨代谢指标、血钙及25(OH)D水平在两组间变化情况。记录脊柱结核伴截瘫患者在随访时间内预后情况[采用美国脊髓损伤学会(ASIA)修订的Frankel截瘫分级评定标准评定],采用多元Logistic回归分析影响脊柱结核伴截瘫患者预后不良的危险因素。结果:(1)研究组患者血钙、CTX-Ⅰ、BAP水平明显高于对照组,25(OH)D水平低于对照组,差异均具有统计学意义(P<0.05)。(2)84例患者治疗后2年随访显示,Frankel分级水平较治疗前明显好转,处于D、E级患者57例,处于D级以下患者27例,预后不良率32.14%。(3)经多元Logistic回归显示:患者无早期康复治疗、无积极治疗,以及血钙、CTX-Ⅰ、BAP水平异常升高和25(OH)D水平异常降低为脊柱结核伴截瘫预后不良的独立危险因素(P<0.05)。结论:骨代谢指标、血钙及25(OH)D在脊柱结核伴截瘫患者中呈异常表达状态,且与患者预后关系密切,可作为预测脊柱结核伴截瘫患者预后的分子标志物和治疗的潜在靶点。

Objective:To study the expression and clinical significance of bone metabolism indexes[Carboxy terminal peptide of typeⅠcollagen(CTX-Ⅰ)and Bone alkaline phosphatase(BAP)],blood calcium and 25-Hydroxy vitamin D[25(OH)D]in patients with spinal tuberculosis combined with paraplegia.Methods:The clinical data of 84 patients with spinal tuberculosis combined with paraplegia who were diagnosed and treated in this hospital from June 2016 to June 2018 were selected as the study group,and 96 normal people who had health examinations during the same period were selected as the control group.The changes in bone metabolism indexes,blood calcium and 25(OH)D levels between the two groups were compared.The prognosis of patients with spinal tuberculosis combined with paraplegia was recorded during the follow-up[assessed by the Frankel Paraplegia Grading Standards revised by the American Spinal Injury Association(ASIA)].The multiple Logistic regression analysis was used to analyze the risk factors that affect the poor prognosis of patients with spinal tuberculosis combined with paraplegia.Results:(1)The blood calcium,CTX-Ⅰ,and BAP levels of the study group were significantly higher than those of the control group,and the 25(OH)D level was lower than that of the control group,the difference was statistically significant(P<0.05).(2)84 patients were followed up for 2 years,the results showed that the Frankel classification level was significantly better than that before treatment.There were 57 patients in grade D or E,and 27 patients in grade below D.The poor prognosis rate was 32.14%.(3)Multiple Logistic regression showed that:no early rehabilitation treatment,no active treatment,abnormal increasing of blood calcium,CTX-Ⅰand BAP levels,and abnormal decreasing of 25(OH)D level were independent risk factors for poor prognosis of patients with spinal tuberculosis combined with paraplegia(P<0.05).Conclusion:Bone metabolism indexes,blood calcium and 25(OH)D are abnormally expressed in patients with spinal tuberculosis combined with paraplegia,and are closely related to the prognosis of patients.They can be used as molecular markers in predicting the prognosis of patients with spinal tuberculosis combined with paraplegia and used as potential targets for treatment point.