自体与异体骨粒治疗胸腰椎结核椎间隙感染的效果及Wnt/β-catenin信号通路表达与预后

Effect of autologous and allogeneic bone particles on treatment of patients with intervertebral space infection of thoracolumbar tuberculosis,expressions of Wnt/β-catenin signaling pathways and prognosis

目的研究自体与异体骨粒治疗胸腰椎结核椎间隙感染的效果及Wnt/β-catenin信号通路表达与预后的关系,以期为该类患者临床治疗以及预后评估提供依据。方法选择2017年8月-2020年10月武汉市东西湖区人民医院收治的胸腰椎结核椎间隙感染手术治疗患者102例为研究对象,其中自体骨粒治疗54例为自体组,异体骨粒治疗48例为异体组。统计两组围术期指标和术后植骨融合、Cobb角、神经功能情况,分析Wnt/β-catenin信号通路对预后的评估价值。结果自体组植骨融合时间较异体组缩短(P<0.05);两组术后植骨融合情况、不同时间点Cobb角、及美国脊柱损伤协会(ASIA)分级比较均无统计学差异;术后随访1年,预后良好组与预后不良组分别有95例、7例,预后良好组Wnt、β-catenin基因相对表达量均高于预后不良组(P<0.05);受试者工作特征(ROC)曲线显示,Wnt和β-catenin相对表达量对胸腰椎结核椎间隙感染患者预后有一定预测价值,曲线下面积(AUC)分别为0.843和0.731。结论针对胸腰椎结核椎间隙感染患者,虽然异体骨粒植骨融合时间较长,但异体骨粒与自体骨粒均对患者神经功能、植骨融合具有较好的改善作用,具有相近的临床效果;Wnt、β-catenin基因相对表达量对预后有一定预测价值。

OBJECTIVE To observe the effect of autologous and allogeneic bone particles on treatment of intervertebral infection of thoracolumbar tuberculosis and analyze the relationship between the expressions of Wnt/β-catenin signaling pathways and the prognosis so as to provide basis for clinical treatment and assessment of prognosis.METHODS A total of 102 patients with intervertebral space infection of thoracolumbar tuberculosis who received surgical procedures in Dongxihu District People′s Hospital from Aug 2017 to Oct 2020 were recruited as the research subjects,54 of whom were treated with autogenous bone particles and were assigned as the autogenous group,48 were treated with allogeneic bone particles and were assigned as the allogeneic group.The perioperative indexes,postoperative bone graft fusion,Cobb angle and neurological function of the two groups of patients were statistically analyzed,and the value of Wnt/β-catenin signaling pathways in assessment of prognosis was observed.RESULTS The time of bone graft fusion of the autologous group was shorter than that of the allogeneic group(P<0.05).There were no significant differences in the postoperative bone graft fusion,Cobb angle at the time points and American Spinal Injury Association(ASIA)grade between the two groups.A 1-year follow-up after the surgery showed that there were 95 cases in the favorable prognosis group and 7 cases in the poor prognosis group;the relative expression levels of Wnt andβ-catenin genes of the favorable prognosis group were higher than those of the poor prognosis group(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the relative expression levels of Wnt andβ-catenin genes had certain value in prediction of prognosis of the patients with intervertebral space infection of thoracolumbar tuberculosis,and the areas under curves(AUCs)were 0.843 and 0.731,respectively.CONCLUSION Although it is long time for bone graft fusion of the allogeneic bone particles among the patients with intervertebral space infection of thoracolumbar tuberculosis,both allogeneic bone particles and autogenous bone particles can improve the neurological function and bone graft fusion,they have the similar clinical effect.The relative expression levels of Wnt andβ-catenin genes have certain value in prediction of prognosis.