血清炎性因子在骨折延迟愈合患者富血小板血浆治疗中的变化

Changes of serum inflammatory factors in patients with delayed fracturehealing with platelet-rich plasma therapy

目的 探讨血清炎性因子在骨折延迟愈合患者富血小板血浆治疗中的变化。方法 选取2020年4月—2021年4月我院收治的98例骨折患者,均予以富血小板血浆联合钢板内固定手术治疗,根据术后6个月内是否发生骨折延迟愈合分为延迟愈合组(37例)和正常愈合组(61例)。分别于骨折后1、4、8、12周采集患者血清样本,采用酶联免疫吸附法检测血清人可溶性细胞间粘附分子-1(sICAM-1)、人可溶性血管细胞粘附分子-1(sVCAM-1)、肿瘤坏死因子-α(TNF-α)等炎症因子水平,并绘制ROC曲线,评估其对骨折延迟愈合的预测价值。采用酶联免疫双抗体夹心法检测血清骨钙素(BGP)、Ⅰ型胶原氨基端肽原(PINP)、碱性磷酸酶(ALP)、胰岛素样生长因子-1(IGF-1)等骨生化代谢指标水平,并采用Pearson分析骨生化代谢指标与炎症因子的关系。结果 骨折1周时,两组患者血清sICAM-1、sVCAM-1、TNF-α等炎症因子水平比较差异无统计学意义(P>0.05);骨折4、8、12周时,延迟愈合组患者血清sICAM-1、sVCAM-1、TNF-α等炎症因子水平均高于正常愈合组(P<0.05),且随着时间推移,两组患者血清sICAM-1、sVCAM-1、TNF-α水平先升高后降低,但延迟愈合组炎症因子水平波动较正常愈合组更明显(P<0.05)。骨折1周时,两组患者血清BGP、PINP、ALP、IGF-1等骨生化代谢指标水平比较差异无统计学意义(P>0.05),且两组各时间点血清ALP水平比较差异无统计学意义(P>0.05);骨折4、8、12周时延迟愈合组患者血清BGP水平逐渐升高并高于正常愈合组,血清IGF-1水平逐渐升高但低于正常愈合组,骨折8、12周时延迟愈合组患者血清PINP水平低于正常愈合组(P<0.05)。Pearson相关性分析结果显示,血清sICAM-1、sVCAM-1、TNF-α等炎症因子水平与血清BGP呈正相关(r=0.523,P<0.001),与血清IGF-1呈负相关(r=-0.467,P<0.001)。ROC曲线分析结果显示,骨折8周时,血清炎症因子水平诊断骨折延迟愈合的曲线下面积高于0.7,提示其具有较好诊断价值,且联合检测对骨折延迟愈合诊断的灵敏度更高(P<0.05)。结论 延迟愈合骨折患者血清sICAM-1、sVCAM-1、TNF-α等炎症因子指标水平随骨折时间增加呈现先升高后降低变化,炎症因子指标水平波动明显,且术后8周时血清炎症因子对预测骨折延迟愈合具有一定参考意义。

Objective To investigate and analyze the changes of serum inflammatory factors in patients with delayed fracture healing in platelet-rich plasma therapy.Methods 98 fracture patients admitted to our hospital from April 2020 to April 2021 were selected and treated with platelet-rich plasma combined with steel plate internal fixation.According to whether delayed fracture union occurred within 6 months after operation,they were divided into delayed union group of 37 cases and 61 cases in the normal healing group.Serum samples were collected from patients at 1 week,4 weeks,8 weeks,and 12 weeks after fracture,and enzyme-linked immunosorbent assay was used to detect serum human soluble intercellular adhesion molecule-1(sICAM-1),human the levels of inflammatory factors such as soluble vascular cell adhesion molecule-1(sVCAM-1),tumor necrosis factor-α(TNF-α),and the ROC curve was drawn according to their levels to evaluate its predictive value for predicting delayed fracture union.Serum bone gla protein(BGP),procollagen typeⅠN-terminal propeptide(PINP),alkaline phosphatase(ALP),the levels of bone biochemical metabolism indexes such as insulin like growth factor-1(IGF-1),and the relationship between bone biochemical metabolism indexes and inflammatory factors were analyzed by Pearosn.Results At 1 week after fracture,there was no difference in serum sICAM-1,sVCAM-1,TNF-αand other inflammatory factor levels between the delayed union group and the normal union group(P>0.05).The levels of serum sICAM-1,sVCAM-1,TNF-αand other inflammatory factors in the healing group were higher than those in the normal healing group(P<0.05).TNF-αlevel first increased and then decreased,but the fluctuation of inflammatory factor levels in the delayed healing group was more obvious than that in the normal healing group(P<0.05).At 1 week after fracture,there was no difference in serum BGP,PINP,ALP,IGF-1 and other bone biochemical metabolism indexes between the delayed healing group and the normal healing group,and there was no difference in serum ALP levels between the two groups at each time point(P>0.05).At 4 weeks,8 weeks,and 12 weeks of fracture,the serum BGP level in the delayed union group gradually increased and was higher than that in the normal union group,and the serum IGF-1 level gradually increased but was lower than that in the normal union group.The level of serum PINP in the healing group was lower than that in the normal healing group(P<0.05).The results of Pearson correlation analysis showed that the levels of serum sICAM-1,sVCAM-1,TNF-αand other inflammatory factors were positively correlated with serum BGP(r=0.523,P=0.000),and negatively correlated with serum IGF-1(r=0.000).0.467,(P=0.000).The results of ROC curve analysis showed that the area under the curve of serum inflammatory factor levels for the diagnosis of delayed fracture union was higher than 0.7 at 8 weeks after fracture,indicating that it has a good diagnostic value,and the combined detection has higher sensitivity for the diagnosis of delayed fracture union(P<0.05).Conclusion The levels of serum sICAM-1,sVCAM-1,TNF-αand other inflammatory factors in patients with delayed union increased first and then decreased with the increase of fracture time.The delayed union of fractures has certain reference significance.