血清IL-6、铁蛋白、25(OH)D3水平变化与骨质疏松性胸腰椎骨折患者保守治疗后骨折未愈合的关系

Relationship between the changes of serum IL-6,ferritin and 25(OH)D3 levels and fracture nonunion in patients with osteoporotic thoracolumbar spine fractures after conservative treatment

目的探讨血清白介素-6(IL-6)、铁蛋白(SF)、25-羟维生素D3[25(OH)D3]水平变化与骨质疏松性胸腰椎骨折患者保守治疗后骨折未愈合的关系。方法随机选取120例接受保守治疗的骨质疏松性胸腰椎骨折患者。治疗3个月后,根据骨折愈合情况分为愈合组(n=94)和未愈合组(n=26)。分析两组治疗前后血清IL-6、SF及25(OH)D3水平变化;收集患者临床资料,分析骨折未愈合的影响因素,并构建预测模型,绘制受试者工作特征(ROC)曲线评估模型的预测效能及血清IL-6、SF、25(OH)D3检测对骨折未愈合的诊断价值。结果治疗3个月后,未愈合组IL-6、SF水平高于愈合组,25(OH)D3水平低于愈合组(P<0.05)。单因素及二元Logistic回归分析显示,合并糖尿病及治疗3个月后IL-6、SF水平高为骨折未愈合的独立危险因素,治疗3个月后25(OH)D3水平高及就诊时骨密度(BMD)T值高为其保护因素(P<0.05)。构建预测模型为:Y=-11.945+2.623×合并糖尿病-3.469×BMD T值+0.882×IL-6+0.027×SF-0.326×25(OH)D3,预测模型的曲线下面积(AUC)为0.948,敏感度为88.50%,特异度为89.40%。血清IL-6、SF、25(OH)D3单独及联合检测对骨折未愈合诊断的AUC为0.809、0.776、0.697、0.894。结论血清IL-6、SF及25(OH)D3水平与骨质疏松性胸腰椎骨折患者保守治疗后骨折愈合状态密切相关,可作为辅助判断骨折未愈合的实验室指标。

Objective To discuss the relationship between the changes of serum interleukin-6(IL-6),ferritin(SF)and 25-hydroxyvitamin D3[25(OH)D3]levels and fracture nonunion in patients with osteoporotic thoracolumbar spine fractures after conservative treatment.Methods 120 patients with osteoporotic thoracolumbar spine fractures who received conservative treatment were randomly selected.After 3 months of treatment,they were divided into the union group(n=94)and the nonunion group(n=26)according to fracture healing status.The changes of serum IL-6,SF and 25(OH)D3 levels in the two groups after treatment were analyzed.The patients'clinical data were collected to analyze the influencing factors of fracture nonunion.A prediction model was constructed.The predictive efficacy of the model and the diagnostic value of serum IL-6,SF and 25(OH)D3 for fracture nonunion were analyzed using the receiver operating characteristic(ROC)curve.Results After 3 months of treatment,the levels of IL-6 and SF in the nonunion group were higher than those in the union group,and the level of 25(OH)D3 was lower than that in the union group(P<0.05).Univariate analysis and binary logistic regression analysis found that diabetes and high levels of IL-6 and SF after 3 months of treatment were independent risk factors for fracture nonunion.High 25(OH)D3 level after 3 months of treatment and high T value of bone mineral density(BMD)at admission were protective factors(P<0.05).The constructed prediction model was as follow:Y=-11.945+2.623×diabetes-3.469×BMD+0.882×IL-6+0.027×SF-0.326×25(OH)D3.The area under the curve(AUC),sensitivity and specificity of the prediction model were 0.948,88.50% and 89.40%.The AUC values of serum IL-6,SF,25(OH)D3 and their combination for diagnosing fracture nonunion were 0.809,0.776,0.697 and 0.894.Conclusion Serum IL-6,SF and 25(OH)D3 levels are closely related to fracture union status in patients with osteoporotic thoracolumbar spine fractures after conservative treatment.They can be used as laboratory indices to help judge fracture nonunion.