老年膝关节骨折患者术后外周血PGC1α、sICAM-1的表达及对骨折恢复的预测价值

Expression of PGC1α and sICAM-1 in peripheral blood of elderly patients with knee fracture after surgery and their predictive value for fracture recovery

目的探究老年膝关节骨折患者术后外周血核受体辅助激活因子(PGC1α)、人可溶性细胞间黏附分子1(sICAM-1)的表达及对骨折恢复的预测价值。方法回顾性选择2019年8月至2022年7月内江市第二人民医院收治的80例老年膝关节骨折患者的病历资料,纳入观察组,并依据骨折情况,分为A组(恢复较差,n=30)、B组(恢复较好,n=50),选择同期健康体检者80例病历资料纳入对照组。比较血清PGC1α、sICAM-1指标水平的差异性表达;影响老年膝关节骨折患者术后骨折恢复的单因素;老年膝关节骨折患者术后影响骨折恢复Logistic回归分析;血清PGC1α、sICAM-1指标水平与骨折恢复指标相关性因素分析;血清PGC1α、sICAM-1指标对骨折恢复的预测价值。结果与对照组相比,A组、B组的PGC1α指标水平明显较低,且A组低于B组[(1.86±0.30)ng/mL vs.(2.85±0.40)ng/mL],sICAM-1指标水平明显较高,且A组高于B组[(196.26±30.26)ng/mL vs.(139.69±21.26)ng/mL],差异均有统计学意义(P<0.05)。A、B组患者骨折恢复效果的单因素分析中,结果提示,年龄、手术时间、骨质疏松、口服维生素、骨密度、血清PGC1α、血清sICAM-1为影响骨折恢复的单因素(P<0.05),性别、是否合并慢性病等因素未对骨折恢复造成显著影响(P>0.05)。纳入Logistic回归结果提示,年龄、骨质疏松、骨密度、PGC1α、sICAM-1为影响骨折恢复的独立危险因素(P<0.05),口服维生素D为骨折术后恢复的保护因素(P=0.031)。老年膝关节骨折患者PGC1α与骨密度呈正相关(r=0.52,P<0.001),与骨质疏松及年龄呈负相关(r=-0.49,P<0.001;r=-0.51,P<0.001),sICAM-1与骨密度呈负相关(r=-0.45,P<0.001),与骨质疏松及年龄呈正相关(r=0.53,P<0.001;r=0.47,P<0.001);PGC1α对骨折恢复预测敏感度、特异度、准确度、阳性及阴性预测值、AUC值及95%CI分别为82.00%、83.33%、82.50%、89.13、73.53、0.699、0.601~0.756;sICAM-1对骨折恢复预测值分别为74.00%、83.33%、77.50%、88.10、65.79、0.656、0.599~0.766;PGC1α与sICAM-1联合检测预测值分别为88.00%、86.67%、87.50%、91.67、81.25、0.910、0.876~0.961。结论老年膝关节骨折术后骨折恢复良好患者血清PGC1α升高,sICAM-1水平降低,年龄、骨质疏松、骨密度、PGC1α、sICAM-1为影响骨折恢复的独立危险因素,而口服维生素D为骨折术后恢复的保护因素。通过PGC1α与sICAM-1联合检测可有效提升骨折术后恢复效果的预测价值。

Objective To investigate the expressions of nuclear receptor coactivator(PGC1α)and soluble intercellular adhesion molecule-1(sICAM-1)in peripheral blood of elderly patients with knee fracture after surgery and their predictive value for fracture recovery.Methods The medical records of 80 elderly patients with knee fracture admitted to The Second People's Hospital of Neijiang between August,2019 and July,2022 were retrospectively selected and included in the observation group.According to the fracture,the patients were divided into group A(poor recovery,n=30)and group B(good recovery,n=50).The differential expression of serum PGC1αand sICAM-1 index levels,single factors affecting postoperative fracture recovery in elderly patients with knee fracture,Logistic regression analysis of postoperative fracture recovery in elderly patients with knee fracture,correlation factor analysis between serum PGC1α,sICAM-1 index levels and fracture recovery index,and serum PGC1 were compared Alpha,sICAM 1 index of fracture restore predictive value.Results Compared with the control group,the level of PGC1αindex in the group A and group B was significantly lower,and the level of sICAM-1 index in the group A was higher than that in the group B[(1.86±0.30)ng/mL vs.(2.85±0.40)ng/mL],and group A was higher than group B[(196.26±30.26)ng/mL vs.(139.69±21.26)ng/mL],the differences were statistically significant(P<0.05).Univariate analysis of fracture recovery effect in group A and B showed that age,operation time,osteoporosis,oral vitamin,bone mineral density,serum PGC1α,and serum sICAM-1 were the single factors affecting fracture recovery(P<0.05),and gender and chronic diseases had no significant effect on fracture recovery(P>0.05).Logistic regression analysis showed that age,osteoporosis,bone mineral density,PGC1αand sICAM-1 were independent risk factors affecting fracture recovery(P<0.005).Oral vitamin D was a protective factor for postoperative fracture recovery(P=0.031).PGC1αwas positively correlated with bone mineral density(r=0.52,P<0.001),and negatively correlated with osteoporosis and age(r=-0.49,P<0.001;r=-0.51,P<0.001).sICAM-1 was negatively correlated with BMD(r=-0.45,P<0.001),and positively correlated with osteoporosis and age(r=0.53,P<0.001;r=0.47,P<0.001).The sensitivity,specificity,accuracy,positive predictive value,negative predictive value,AUC and 95%CI of PGC1αin predicting fracture recovery were 82.00%,83.33%,82.50%,89.13,73.53,0.699,0.601-0.756,respectively.The predictive values of sICAM-1 for fracture recovery were 74.00%,83.33%,77.50%,88.10,65.79,0.656,0.599-0.766,respectively.The predicted values of PGC1αcombined with sICAM-1 were 88.00%,86.67%,87.50%,91.67,81.25,0.910 and 0.876 to 0.961,respectively.Conclusion In elderly patients with good postoperative recovery of knee fractures,serum PGC1 level increase and sICAM-1 level decrease.Age,osteoporosis,bone mineral density,PGC1,and sICAM-1 are independent risk factors affecting fracture recovery,while oral vitamin D is a protective factor for postoperative recovery.The combined detection of PGC1αand sICAM-1 can effectively improve the predictive value of the recovery effect after fracture surgery.