摘要
目的分析股骨粗隆间骨折固定术后感染的危险因素及其对转化生长因子-β/骨形成蛋白(TGF-β/BMPs)信号通路和骨代谢指标的影响。方法选取2014年8月-2019年8月于内蒙古民族大学附属医院接受股骨粗隆间骨折固定术患者650例,根据术后感染情况分为感染组30例和未感染组620例。检测感染组病原菌分布。记录两组患者糖尿病史、AO分型、手术时间、留置导尿管等一般资料。比较两组患者感染确诊后TGF-β/BMPs信号通路表达和血清炎症因子水平、骨代谢指标、髋关节评分(Harris评分)。Logistic回归分析影响术后感染的危险因素。结果感染组感染革兰阳性菌共29株占59.18%;合并糖尿病和留置导尿管为影响术后感染的危险因素;感染组外周血单个核细胞中TGF-β、BMP-2、Smad-1、Smad-2、Smad-3蛋白表达和血清肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、降钙素原(PCT)水平、β-胶原特殊序列(β-CTX)均高于未感染组(P<0.05),血清白细胞介素-10(IL-10)、骨钙素(OC)、降钙素(CT)、骨性碱性磷酸酶(BALP)、1型前胶原氨基端肽(PⅠNP)水平低于未感染组(P<0.05);感染组患者术后3、6、9和12个月Harris评分均低于未感染组(P<0.05)。结论股骨粗隆间骨折固定术后感染会激活TGF-β/BMPs信号通路,诱发炎症反应,降低骨代谢指标,影响预后。
OBJECTIVE To analyze the risk factors for infection after intertrochanteric fracture fixation and its effect on transforming growth factor-β/bone morphogenetic protein(TGF-β/BMPs)signaling pathway and bone metabolism indexes.METHODS A total of 650 patients who underwent femoral intertrochanteric fracture fixation in Affiliated Hospital of Inner Mongolia University for Nationalities from Aug 2014 to Aug 2019 were enrolled.According to postoperative infection situations,they were divided into the infection group(30 cases)and non-infection group(620 cases).The distribution of pathogens in the infection group were detected.The general data of two groups,such as diabetes history,AO classification,operative time,indwelling catheter,etc.were recorded.The relative expression levels of TGF-β/BMPs pathway proteins,levels of serum inflammatory cytokines and Harris scores were compared between the two groups.The risk factors for postoperative infection were analyzed by multivariate Logistic regression analysis.RESULTS In the infection group,there were 29 strains of(59.18%)Gram-positive bacteria.Diabetes mellitus and indwelling catheter were the risk factors for infection after intertrochanteric fracture fixation.The relative expression of TGF-β,BMP-2,Smad-1,Smad-2,Smad-3 proteins in peripheral blood mononuclear cells,and serum levels of tumor necrosis factorα(TNF-α),C-reactive protein(CRP),calcitonin(PCT),andβ-collagen special sequence(β-CTX)in the infection group were significantly higher than those in the non-infection group(P<0.05),while serum interleuk-10(IL-10),osteocalcin(OC),calcitonin(CT),consisting of alkaline phosphatase(BALP)and type 1 collagen amino end before peptide(PⅠNP)level were significantly lower than those in the non-infection group(P<0.05).Harris scores in the infected group 3 months,6 months,9 months and 12 months after surgery were significantly lower than those in non-infection group(P<0.05).CONCLUSION Infection after femoral intertrochanteric fracture fixation will activate TGF-β/BMPs signaling pathway,induce inflammatory reactions and reduce bone metabolism indexes,which can have some adverse effect on prognosis.
作者
马冰心
刘金山
金红光
王玉鑫
胡静
MA Bing-xin;LIU Jin-shan;JIN Hong-guang;WANG Yu-xin;HU Jing(Affiliated Hospital of Inner Mongolia University for Nationalities,Tongliao,Inner Mongolia 028001,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2021年第23期3581-3585,共5页
Chinese Journal of Nosocomiology
基金
内蒙古自治区自然科学面上项目(NJZY173)
关键词
股骨粗隆间骨折固定术
转化生长因子-β/骨形成蛋白信号通路
炎症因子
骨代谢
髋关节评分
Femoral intertrochanteric fracture fixation
Transforming growth factor-β/bone morphogenetic protein signaling pathway
Inflammatory factor
Bone metabolism
Hip score
