摘要
目的 探究表皮生长因子(EGF)、C1q/TNF相关蛋白3(CTRP3)及骨代谢水平与上肢骨折愈合的相关性.方法 前瞻性选取2019年6月至2023年11月西安交通大学附属红会医院收治的90例上肢骨折患者为研究对象,根据术后6个月骨折愈合情况分为正常愈合组(n=67)、延迟愈合组(n=23).对比两组患者EGF、CTRP3及骨代谢相关指标[β-Ⅰ型胶原羧基端肽(β-CTx)、可溶性黏附分子CD44(sCD44)、成纤维细胞生长因子-2(FGF-2)]水平.采用多因素Logistic回归分析影响上肢骨折患者正常愈合的因素;采用受试者操作特征(ROC)曲线分析EGF、CTRP3、β-CTX、sCD44、FGF-2对上肢骨折正常愈合的预测价值.结果 术后7 d,两组患者EGF、CTRP3水平均较术后1 d升高,且正常组患者EGF、CTRP3水平分别为(0.98±0.16)、(217.85±51.05)pg/mL,均高于延迟组[(0.87±0.12)、(144.62±41.95)pg/mL],差异均有统计学意义(P＜0.05).术后 7 d,两组患者β-CTX、sCD44、FGF-2 水平均较术后1 d升高,且正常组患者的β-CTX、FGF-2水平分别为(0.82±0.26)ng/mL、(30.00±7.65)ng/L,均高于延迟组[(0.61±0.15)ng/mL、(25.67±7.26)ng/L)],而 sCD44 水平为(283.20±24.17)ng/mL,低于延迟组[(312.66±33.25)ng/mL],差异均有统计学意义(P＜0.05).经多因素Logistic回归分析,术后7 d EGF、CTRP3、β-CTX、sCD44、FGF-2表达均为影响上肢骨折患者愈合的独立危险因素(P＜0.05).经ROC曲线分析,术后7 d的EGF、CTRP3、β-CTX、sCD44水平表达均对上肢骨折患者正常愈合有较高的预测价值,曲线下面积(AUC)值分别为0.719、0.868、0.741、0.812.结论 上肢骨折正常愈合患者EGF、CTRP3、β-CTX、FGF-2水平高于延迟组,而sCD44低于延迟组,EGF、CTRP3、β-CTX、sCD44水平表达均对上肢骨折患者正常愈合有较高的预测价值.
Abstract
Objective To explore the correlation of epidermal growth factor(EGF),C1q/TNF related protein 3(CTRP3),and bone metabolism levels with upper limb fracture healing.Methods Ninety patients with upper limb fractures admitted to Red Society Hospital affiliated to Xian Jiaotong University from June 2019 to November 2023 were prospectively selected as the research subjects.Based on the fracture healing situation 6 months after operation,they were divided into the normal group(n=67)and the delayed group(n=23).The levels of EGF,CTRP3,and bone metabolism related indicators[β-C-terminal telopeptide of type 1 collagen(β-CTx),soluble adhesion moleculeCD44(sCD44),fibroblast growth factor-2(FGF-2)]between two groups of patients before operation and 7 days after operation were compared.The factors affecting the normal healing of patients with upper limb fracture were analyzed by multivariate Logistic regression analysis.The predictive value of EGF,CTRP3,β-CTX,sCD44,and FGF-2 for normal healing of upper limb fractures was analyzed using the receiver operating char-acteristic(ROC)curve.Results At 7 days after operation,the levels of EGF and CTRP3 in the two groups were higher than those at 1 day after operation,and the levels of EGF and CTRP3 in the normal group were(0.98±0.16)and(217.85±51.05)pg/mL,respectively,which were higher than those in the delayed group[(0.87±0.12)and(144.62±41.95)pg/mL],and the differences were statistically significant(P＜0.05).At 7 days after operation,the levels of β-CTX,sCD44 and FGF-2 in the two groups were higher than those at 1 day after operation,and the levels of β-CTX and FGF-2 in the normal group were(0.82±0.26)ng/mL and(30.00±7.65)ng/L,respectively,which were higher than those in the delayed group[(0.61±0.15)ng/mL,(25.67±7.26)ng/L],while the level of sCD44 was(283.20±24.17)ng/mL,which was lower than that in the delayed group[(312.66±33.25)ng/mL],the differences were statistically significant(P＜0.05).Ac-cording to Logistic regression analysis,the expression of EGF,CTRP3,β-CTX,sCD44,and FGF-2 at 7 days after operation were all inde-pendent risk factors affecting the healing of upper limb fracture patients(P＜0.05).According to ROC curve analysis,the levels of EGF,CTRP3,β-CTX,and sCD44 at 7 days after operation all had high predictive value for normal healing in patients with upper limb fractures,with area under the curve(AUC)values of 0.719,0.868,0.741,and 0.812,respectively.Conclusion The levels of EGF,CTRP3,β-CTX,and FGF-2 in patients with normal healing of upper limb fractures are higher than those in the delayed group,while sCD44 is lower than that in the delayed group.The expression of EGF,CTRP3,β-CTX,and sCD44 levels all have high predictive value for normal healing of upper limb fractures in patients.
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