摘要
目的 探讨血清反应因子(SRF)、核因子κB(NF-κB)及转化生长因子-β1(TGF-β1)在脊柱骨折脊髓损伤患者中表达意义及其与患者术后预后的相关性.方法 回顾性选取2020年10月至2023年10月榆林市第一医院收治的98例脊柱骨折患者作为研究对象,依照是否合并脊髓损伤进行分组,分为脊髓损伤组(n=60)和非脊髓损伤组(n=38),另选取同期来本院体检的50名健康者作为对照组.对60例脊柱骨折脊髓损伤患者进行术后3个月随访,预后良好20例和预后不良40例.比较3组受检者SRF、NF-κB及TGF-β1表达水平,采用Pearson相关性分析分析SRF、NF-κB及TGF-β1与脊柱骨折脊髓损伤的相关性,并采用受试者操作特征(ROC)曲线明确SRF、NF-κB及TGF-β1对脊柱骨折脊髓损伤的诊断价值.采用多因素Logistic回归模型分析脊柱骨折脊髓损伤预后的独立危险因素.结果 3组受检者SRF、NF-κB及TGF-β1水平比较,差异均有统计学意义(P＜0.05),其中,脊髓损伤组SRF水平为(112.57±18.24)pg/mL,低于非脊髓损伤组[(165.80±23.82)pg/mL]和对照组[(330.43±42.64)pg/mL],NF-κB、TGF-β1 水平分别为(22.19±6.24)、(10.53±2.73)ng/mL,均高于非脊髓损伤组[(10.23±3.16)、(7.63±1.47)ng/mL]和对照组[(7.85±1.84)、(5.65±0.84)ng/mL],差异均有统计学意义(P＜0.05).SRF、NF-κB、TGF-β1 的表达均与脊柱骨折脊髓损伤密切相关(r=0.531、0.541、0.558,P＜0.05);SRF、NF-κB及TGF-β1三者联合对脊柱骨折脊髓损伤的诊断敏感度、特异度及曲线下面积分别为92.53％、87.49％、0.892,明显高于三者单一诊断(P＜0.05).多因素Logistics回归模型分析显示,SRF、NF-KB、TGF-β1、椎管侵占率是影响脊柱骨折脊髓损伤预后不良的独立危险因素(P＜0.05).结论 脊柱骨折脊髓损伤患者SRF水平明显降低,NF-κB及TGF-β1水平明显升高,三者与脊髓损伤密切相关.SRF、NF-κB及TGF-β1可作为诊断脊柱骨折脊髓损伤的可靠血清标志物,联合诊断可提升脊柱骨折脊髓损伤的诊断效能.同时,SRF、NF-κB及TGF-β1水平对于脊柱骨折脊髓损伤患者的预后预测价值较高.
Abstract
Objective To explore serum response factor(SRF)and nuclear factor κB(NF-κB)and transforming growth factors-β1(TGF-β1)expression significance and their correlation with postoperative prognosis in patients with spinal fracture and spinal cord injury.Methods This study was a retrospective analysis of 98 spinal fracture patients admitted to The First Hospital of Yulin from October 2020 to Octo-ber 2023.They were divided into the spinal cord injury group(n=60)and the non spinal cord injury group(n=38)according to whether combine with spinal cord injury.Additionally,50 healthy individuals who came to The First Hospital of Yulin for physical examination during the same period were selected as the control group.Sixty patients with spinal fractures and spinal cord injuries were followed up for 3 months after sur-gery,with 20 having a good prognosis and 40 having a poor prognosis.The levels of SRF,NF-κB and TGF-β1 of the three groups were com-pared.The correlation between SRF,NF-κB and TGF-β1 with spinal fracture and spinal cord injury was analyzed using Pearson's correlation a-nalysis.The diagnostic value of SRF,NF-κB and TGF-β1 for spinal fracture and spinal cord injury was clearly determined using receiver op-erating characteristic(ROC)curves.The independent risk factors for spinal fracture and spinal cord injury were analyzed using a logistic regres-sion model.Results There were statistically significant differences in the levels of SRF,NF-κB and TGF-β1 among the three groups(P＜0.05).Among them,the level of SRF in the spinal cord injury group was(112.57±18.24)pg/mL,which was lower than that in the non spinal cord injury group[(165.80±23.82)pg/mL]and the control group[(330.43±42.64)pg/mL],the levels of NF-κB and TGF-β1 were(22.19±6.24)and(10.53±2.73)ng/mL,respectively,which were higher than those in the non spinal cord injury group[(10.23±3.16),(7.63±1.47)ng/mL]and the control group[(7.85±1.84)ng/mL,(5.65±0.84)ng/mL],respectively,the differences were statistically significant(P＜0.05).The expressions of SRF,NF-κB,TGF-β1 were closely related to spinal fracture and spinal cord injury(r=0.531,0.541,0.558,P＜0.05).The diagnostic sensitivity,specificity,and area under the curve of SRF,NF-κB and TGF-1 β combined for spinal fracture and spinal cord injury were 92.53％,87.49％,and 0.892,respectively,significantly higher than the single diagnosis of the three(P＜0.05).Multivariate analysis showed that SRF,NF-κB and TGF-1 β,and spinal encroachment rate were independent risk factors for the poor prognosis of spinal fractures(P＜0.05).Conclusion The SRF level is significantly reduced,while NF-κB and TGF-1β levels are signifi-cantly increased in patients with spinal fracture and spinal cord injury.SRF,NF-κB and TGF-1β can serve as a reliable serum marker for diag-nosing spinal fracture and spinal cord injury,and combined diagnosis can improve the diagnostic efficacy of spinal fracture and spinal cord injury.Meanwhile,SRF and NF-κB and TGF-1 β levels has high predictive value for the prognosis of patients with spinal fracture and spinal cord injury.
维普
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