术前血清SRF、SBDP145、CysC水平对脊柱骨折合并脊髓损伤患者术后预后的预测价值

The prognostic value of preoperative serum SRF,SBDP145 and CysC in patients with spinal fracture complicated with spinal cord injury after surgical treatment 16:182023/5/31

目的探讨术前血清反应因子(SRF)、αⅡ-血影蛋白分解产物-145(SBDP145)、胱抑素C(CysC)对脊柱骨折合并脊髓损伤(SCI)患者术后预后的预测价值。方法选取2019年2月至2021年2月该院收治的100例脊柱骨折合并SCI患者为研究对象,治疗后随访1年,将其按照预后情况分为预后不良组和预后良好组。检测并比较两组术前血清SRF、SBDP145、CysC水平及各项基线资料,采用多因素Logistic回归分析脊柱骨折合并SCI患者预后的影响因素,并采用受试者工作特征(ROC)曲线分析血清SRF、SBDP145、CysC预测预后不良的效能。结果预后不良组术前血清SRF水平为(90.12±10.30)pg/mL,低于预后良好组的(144.58±12.38)pg/mL,预后不良组血清SBDP145、CysC水平分别为(10.37±1.34)ng/mL、(1.72±0.38)mg/L,高于预后良好组的(8.42±1.05)ng/mL、(0.51±0.12)mg/L,差异有统计学意义(P<0.05)。单因素分析结果显示,预后不良组中椎管侵占率≥50%、受伤至使用激素类药物时间≥8 h及多节段SCI人数比例分别为63.16%、65.79%、71.05%,均高于预后良好组的35.48%、43.55%、41.94%,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,椎管侵占率≥50%、受伤至使用激素类药物时间≥8 h、多节段SCI、血清SRF水平降低、SBDP145水平升高、CysC水平升高是脊柱骨折合并SCI患者术后预后不良的危险因素(P<0.05)。术前血清SRF、SBDP145、CysC 3项指标联合检测预测脊柱骨折合并SCI患者术后预后不良的曲线下面积(95%CI)为0.839(0.728~0.956)。结论血清SRF水平降低、SBDP145和CysC水平升高与脊柱骨折合并SCI患者术后的预后不良有关,术前血清SRF、SBDP145、CysC联合检测预测脊柱骨折合并SCI患者预后不良的价值较高。

Objective To investigate the prognostic value of preoperative serum response factor(SRF),αⅡ-haemoglobin breakdown product-145(SBDP145)and cystatin C(CysC)in patients with spinal fracture complicated with spinal cord injury(SCI).Methods A total of 100 patients with spinal fracture complicated with SCI admitted to No.215 Hospital Shaanxi Nuclear Industry from February 2019 to February 2021 were selected as the study objects,followed up for 1 year after treatment,and divided into poor prognosis group and good prognosis group according to the prognosis.Preoperative serum levels of SRF,SBDP145,CysC and baseline data were compared between the two groups.Multivariate Logistic regression was used to analyze the influencing factors of prognosis in patients with spinal fracture complicated with SCI.Receiver operating characteristic(ROC)curve was used to analyze the efficacy of serum SRF,SBDP145 and CysC in predicting poor prognosis.Results The preoperative serum SRF level of the poor prognosis group was(90.12±10.30)pg/mL,which was lower than that of the good prognosis group(144.58±12.38)pg/mL,the serum SBDP145 and CysC levels of the poor prognosis group were(10.37±1.34)ng/mL and(1.72±0.38)mg/L respectively,which were higher than those in good prognosis group[(8.42±1.05)ng/mL and(0.51±0.12)mg/L],the differences were statistically significant(P<0.05).Univariate analysis showed that the proportions of spinal canal invasion rate≥50%,time≥8 h from injury to hormone drug use and multi-level SCI in the poor prognosis group were 63.16%,65.79%and 71.05%respectively,which were higher than those in the good prognosis group(35.48%,43.55%and 41.94%),the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that spinal canal invasion rate≥50%,time≥8 h from injury to hormone drug use,multi-level SCI,decreased serum SRF level,increased SBDP145 level and increased CysC level were risk factors for poor prognosis in patients with spinal fracture complicated with SCI after surgery(P<0.05).The area under the curve(95%CI)of combined preoperative serum SRF,SBDP145 and CysC in predicting postoperative poor prognosis of patients with spinal fracture complicated with SCI was 0.839(0.728-0.956).Conclusion Decreased serum SRF levels,increased SBDP145 and CysC levels associate with poor prognosis in patients with spinal fracture complicated with SCI after surgical treatment.Preoperative combination of serum SRF,SBDP145 and CysC is of high value in predicting poor prognosis in patients with spinal fracture complicated with SCI.