老年股骨颈骨折患者血清指标与术后延迟愈合的关系初探

Relationship between serum indicators of elderly patients with femoral neck fractures and postoperative delayed healing

中文关键词: 老年    25-羟维生素D    中性粒细胞明胶酶相关载脂蛋白    β-骨胶原交联    骨折延迟愈合    预测价值

英文关键词: elderly  25-hydroxyvitamin D  neutrophil gelatinase-associated lipocalin  crosslaps  delayed fracture healing  predictive value

中文摘要:

      目的 探讨老年股骨颈骨折患者血清25-羟维生素D[25（OH）D]、中性粒细胞明胶酶相关载脂蛋白（NGAL）、β-骨胶原交联（β-CTX）的表达水平，并分析三者与术后骨折延迟愈合的关系及预测价值。方法 回顾性分析2023年1月至2025年1月，于上海中医药大学附属曙光医院检验科接受检查的146例老年股骨颈骨折行空心螺钉内固定术治疗的患者资料。于术后6个月，根据患者临床表现、影像学检查结果、临床愈合标准将其分为骨折愈合良好组（n=112）和骨折延迟愈合组（n=34）。收集患者的一般资料，比较2组患者术前采集的静脉血血清25（OH）D、NGAL、β-CTX水平，采用Logistic回归分析骨折延迟愈合的独立危险因素，绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC）以评估各指标及联合指标对骨折延迟愈合的预测价值。结果 骨折延迟愈合组的骨密度为（0.63±0.09）g/m²,明显低于骨折愈合良好组（0.73±0.12）g/m²（P<0.05）。骨折延迟愈合组的血清25（OH）D为（19.73±3.64）ng/mL,明显低于骨折愈合良好组的（28.25±4.95）ng/mL,而血清NGAL、Β-CTX水平分别为（186.87±23.25）ng/mL、（0.78±0.15）ng/mL,明显高于骨折愈合良好组的（132.85±16.91）ng/mL、（0.55±0.13）ng/mL（P<0.05）。Logistic回归分析显示，低血清25（OH）D（OR=0.559,95%CI:0.350～0.893）、高血清NGAL（OR=1.865,95%CI:1.339～2.597）、高血清β-CTX（OR=1.834,95%CI:1.144～2.941）、低骨密度（OR=0.487,95%CI:0.261～0.908）是老年骨折患者术后发生骨折延迟愈合的独立危险因素（P<0.05）。ROC曲线结果显示，血清25（OH）D、NGAL、β-CTX、骨密度单独预测老年骨折患者术后骨折延迟愈合的AUC分别为0.895、0.922、0.903、0.759,而联合预测的AUC为0.961,优于各指标单独预测价值（P<0.05）。结论 老年骨折患者血清25（OH）D低表达、NGAL、β-CTX高表达及低骨密度对术后骨折延迟愈合具有较高预测价值，且联合检测可提高预测效能。

英文摘要:

      Objective To explore the expression levels of serum 25-hydroxyvitamin D[25(OH)D],neutrophil gelatinase-associated lipocalin(NGAL),and β-collagen crosslaps(β-CTX)in in elderly femoral neck fracture patients,and to analyze their relationship with delayed fracture healing after surgery and their predictive value.Methods A retrospective analysis was conducted on the patient data of 146 cases of elderly femoral neck fractures treated with hollow screw internal fixation,which were examined in the clinical laboratory of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2023 to January 2025.Following a six-month post-operative period,participants were stratified into two groups,the good fracture healing group(n=112)and the delayed fracture healing group(n=34),based on clinical presentation,radiographic findings,and established clinical healing criteria.The general information of the patients was collected.Venous blood samples were collected from the patients before the surgery to detect and compare the levels of serum indicators[25(OH)D,NGAL,β-CTX]between the two groups.Independent risk factors for delayed fracture union were identified via Logistic regression analysis.The predictive performance of individual and combined indicators for delayed fracture union was assessed by generating receiver operating characteristic(ROC)curves and calculating the corresponding area under the curve(AUC).Results The bone density of the delayed fracture healing group was(0.63±0.09)g/m2,significantly lower than that of the good fracture healing group,which was(0.73±0.12)g/m2(P<0.05).The serum25(OH)Dlevel in the group with delayed fracture healing was(19.73±3.64)ng/mL,which was significantly lower than that in the group with good fracture healing[(28.25±4.95)ng/mL].Meanwhile,the serum NGAL and β-CTX levels were(186.87±23.25)ng/mL and(0.78±0.15)ng/mL respectively,which were significantly higher than those in the group with good fracture healing[(132.85±16.91)ng/mL and(0.55±0.13)ng/mL](P<0.05).Logistic regression analysis revealed that low serum 25(OH)D(OR=0.559,95%CI:0.350-0.893),high serum NGAL(OR=1.865,95%CI:1.339-2.597),high serum β-CTX(OR=1.834,95%CI:1.144-2.941),and low bone density(OR=0.487,95%CI:0.261-0.908)were independently associated with delayed fracture healing in elderly patients after surgical management(P<0.05).ROC curve analysis indicated that the AUC for serum 25(OH)D,NGAL,β-CTX,and bone density in predicting delayed fracture healing after surgery in elderly patients were 0.895,0.922,0.903,and 0.759,respectively.The combined model yielded a significantly higher AUC of 0.961,demonstrating enhanced predictive power(P<0.05).Conclusion Low expression of serum 25(OH)D,high expression of NGAL and β-CTX and low bone density in elderly patients with fractures have high predictive value for delayed fracture healing after surgery,and combined detection can improve the predictive efficiency.