血清瘦素及骨转化指标与下肢长骨骨折伴急性脊髓损伤患者骨折愈合的关系-东南大学学报医学版

血清瘦素及骨转化指标与下肢长骨骨折伴急性脊髓损伤患者骨折愈合的关系

单位：长沙市第四医院神经脊柱外科, 湖南长沙 410000

分类号：R681.5;R683.42

出版年·卷·期（页码）：2022·41·第一期（49-55）

摘要：

目的：分析血清瘦素、骨转化指标的变化与下肢长骨骨折伴急性脊髓损伤（SCI）患者骨折愈合的关系。方法：选取2018年3月至2021年2月我院收治的127例下肢长骨骨折患者，其中伴有急性SCI者67例作为SCI组，不伴有SCI患者60例作为骨折组，另选取非骨折的志愿者60例作为对照组。检测3组受试者血清瘦素、骨转化标志物Ⅰ型胶原蛋白C末端交联肽（CTX-1）、骨特异碱性磷酸酶（BALP）、1型胶原蛋白氨基端前胶原肽（P1NP）、骨钙素（OC）水平。比较2组骨折患者术后3个月Lane-Sandhu评分。结果：在术后1、7、14 d时，骨折组和SCI组血清瘦素水平均高于对照组（P<0.05）；在术后7 d和14 d时血清CTX-1、BALP水平以及在术后1、7 d时血清P1NP和OC水平均高于对照组（P<0.05）。骨折组和SCI组血清瘦素水平变化趋势存在统计学差异（F_{时间×组别}=4.565，P=0.012）。经Spearman法分析，SCI组患者术后1 d时血清瘦素水平与股骨颈BMD均呈负相关性（r_s=-0.492，P<0.05），与术后3个月Lane-Sandhu评分呈正相关性（r_s=0.724，P<0.05）。经多因素Logistic回归分析，术后1 d时股骨颈BMD和血清瘦素水平升高是影响术后骨折愈合的独立保护因素（P<0.05）。结论：对于伴有急性SCI的下肢长骨骨折患者，在术后14 d内血清瘦素一直保持较高水平，这可能是加速SCI患者骨折愈合速度的主要因素之一。

Objective: To investigate the relationship between serum leptin, bone turnover biomarkers and fracture healing in patients with lower extremity long bone fracture and acute spinal cord injury(SCI).Methods: A total of 127 patients with lower extremity long bone fracture admitted to our hospital from March 2018 to February 2021 were selected, including 67 patients with acute SCI as the SCI group, 60 patients without SCI as the fracture group. 60 volunteers without fracture were selected as the control group. Serum leptin, bone transformation marker type Ⅰ collagen C-terminal cross-linked peptide(CTX-1), bone specific alkaline phosphatase(BALP), type 1 collagen amino-terminal procollagen peptide(P1NP) and osteocalcin(OC) levels were detected in 3 groups. Lane-Sandhu scores of fracture patients in 2 groups were compared at 3 months after surgery.Results: The serum leptin level of fracture group and SCI group was higher than that of the control group on the 1^st, 7^th or 14^th day after operation(P<0.05). The serum levels of CTX-1 and BALP on the 7^th or 14^th day after operation and the serum levels of P1NP and OC on the 1^st or 7^th day after operation were higher than those in the control group(P<0.05). There was statistically significant difference in the change trend of serum leptin level between the fracture group and the SCI group(F_time×group=4.565, P=0.012). Spearman analysis showed that serum leptin level in SCI group on the 1^st day after operation was negatively related with BMD of femoral neck(r_s=-0.492, P<0.05) and positive related with Lane-Sandhu score at 3 months after operation(r_s=0.724, P<0.05). Multivariate Logistic regression analysis showed that the increase of femoral neck BMD and serum leptin level on the 1^st day after operation were both independent protective factors of fracture healing(P<0.05).Conclusion: For patients with lower extremity long bone fracture with acute SCI, the serum leptin level remains high within 14 days after surgery, which may be one of the main factors accelerating the fracture healing rate of patients in the SCI group.

参考文献：

[1] MAIMOUN L, BEN BOUALLEGUE F, GELIS A, et al.Periostin and sclerostin levels in individuals with spinal cord injury and their relationship with bone mass, bone turnover, fracture and osteoporosis status[J].Bone, 2019, 127:612-619.
[2] GARBE A, GRAEF F, APPELT J, et al.Leptin mediated pathways stabilize posttraumatic insulin and osteocalcin patterns after long bone fracture and concomitant traumatic brain injury and thus influence fracture healing in a combined murine trauma model[J].Int J Mol Sci, 2020, 21(23):9144.
[3] WANG L, LIU L, PAN Z, et al.Serum leptin, bone mineral density and the healing of long bone fractures in men with spinal cord injury[J].Bosn J Basic Med Sci, 2015, 15(4):69-74.
[4] DAOUd A, HAIDER S, SANKARI A.Noninvasive ventilation and spinal cord injury[J].Sleep Med Clin, 2020, 15(4):461-470.
[5] JI X H, WANG J J, GUO Y, et al.The effect of bisphosphonates on managing osteoporosis after spinal cord injury:a meta-analysis[J].Curr Pharm Des, 2020, 26(39):5072-5078.
[6] 王东明.系统化干预在脊柱骨折伴脊髓损伤手术室护理中的效果分析[J].中国伤残医学, 2020, 28(6):65-66.
[7] NIEMI-NIKKOLA V, SAIJIETS N, YLIPOUSSU H, et al.Traumatic spinal injuries in Northern Finland[J].Spine, 2018, 43(1):E45-E51.
[8] WANG H, WU D, XU W, et al.Extremity fractures in patients presenting with traumatic spinal fractures and spinal cord injury[J].Medicine (Baltimore), 2020, 99(4):e18789.
[9] RODRIGUEZ-MERCHAN E C.A review of recent developments in the molecular mechanisms of bone healing[J].Int J Mol Sci, 2021, 22(2):767.
[10] 王来旭, 张健, 王磊, 等.骨生化相关指标与骨折愈合关系的研究[J].中国医学创新, 2019, 16(36):124-127.
[11] REID I R, BALDOCK P A, CORNISH J.Effects of leptin on the skeleton[J].Endocr Rev, 2018, 39(6):938-959.
[12] NAKAMURA Y, NAKANO M, SUZUKI T, et al.Two adipocytokines, leptin and adiponectin, independently predict osteoporotic fracture risk at different bone sites in postmenopausal women[J].Bone, 2020, 137:115404.
[13] 梁雨丝, 达娜, 梁杰.新疆地区老年女性骨量减少:血清瘦素与骨密度及其相关指标[J].中国组织工程研究, 2015, 19(29):4619-4623.
[14] WANG L, SUN S, YANG L, et al.Effects of leptin on femoral fracture in rats[J].J Biomed Res, 2018, 32(2):130-135.
[15] ZHAO H, QI C, ZHENG C, et al.Effects of glycated hemoglobin level on bone metabolism biomarkers in patients with type 2 diabetes mellitus[J].Diabetes Metab Syndr Obes, 2020, 13:1785-1791.
[16] RAPUN-LOPEZ M, OLMEDILLAS H, GONZALEZ-AGUERO A, et al.May young elite cyclists have less efficient bone metabolism?[J].Nutrients, 2019, 11(5):1178.
[17] RYL A, SZYLINSKA A, JUREWICZ A, et al.Analysis of the relationship between the levels of androgens and biochemical bone markers in men aged 60-75 years[J].Int J Environ Res Public Health, 2019, 17(1):106.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录