血清VEGF及VCAM-1水平与股骨颈骨折术后延迟愈合的相关性研究

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摘要目的分析血清血管内皮生长因子(vascular endothelial groxth factor，VEGF)、血管细胞黏附分子-1(vascular cell adhesion molecule-1，VCAM-1)水平对股骨颈患者延迟愈合的影响，评价各指标对延迟愈合的预测价值。方法回顾性分析新疆医科大学第六附属医院2017年3月至2019年5月期间，完成治疗与术后随访的189份股骨颈骨折患者资料，以术后6个月为研究时间点，纳入其中40例符合入选标准的股骨颈骨折术后延迟愈合患者作为延迟愈合组，40例愈合良好的患者作为无延迟愈合组；回顾抽取同期医院接受常规体检并证实为健康人的40例健康人群资料，作为健康对照组。全部入组者均于入院时接受常规检查、实验室相关指标检查，且检查结果资料完整，主要记录三组入院时血清VEGF、VCAM-1水平检测结果，记录两组股骨颈骨折患者术后4、8、12周血清VEGF、VCAM-1水平检测结果。分析术后各时点血清指标间的相关性，围手术期各血清水平的变化对股骨颈骨折术后延迟愈合的影响，绘制操作者特征(receiver operating characteristic，ROC)曲线检验各时点、各血清指标对延迟愈合的预测价值。结果入院时80例股骨颈骨折患者血清VEGF水平低于对照组，WCAM-1水平高于对照组(P＜0.05)；延迟愈合组术后各时点VEGF水平低于无延迟愈合组，VCAM-1水平高于无延迟愈合组，差异有统计学意义(P＜0.05)；股骨颈骨折患者术后4周、8周的血清VEGF、VCAM-1水平之间呈负相关(r＝－0.513，P＜0.05)，且以术后4周相关性最强；术后12周，二者间无相关性；经线性回归分析检验结果显示，围手术期血清VEGF、VCAM-1水平变化可能是股骨颈骨折患者术后延迟愈合影响因素(P＜0.05)；术后各时点，血清VEGF、VCAM-1水平对股骨颈骨折术后延迟愈合均有一定预测价值［曲线下面积(area under curve，AUC)＞0.7，P＜0.05］，且以术后8周预测价值最高，对应的AUC分别为0.766、0.781。结论股骨颈骨折患者术后血清VEGF与VCAM-1间可相互作用，与术后延迟愈合密切相关，可能是术后延迟愈合的影响因素。动态监测患者术后各时点血清VEGF与VCAM-1水平的变化，可以很好的预测骨折延迟愈合的风险，指导临床合理防治，减少延迟愈合发生。

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	巨啸晨
	舒莉
	周玲
	孙荣鑫 *

关键词 ：股骨颈骨折, 延迟愈合, 血管内皮生长因子, 血管细胞黏附因子-1, 相关性

Abstract：Objective To analyze the effect of serum vascular endothelial growth factor(VEGF) and vascular cell adhesion molecule-1(VCAM-1) levels on delayed healing of patients with femoral neck fracture，and to evaluate the predictive value of each index in delayed healing.Methods The clinical data of 189 patients with femoral neck fracture who completed treatment and postoperative follow-up in the Sixth Affiliated Hospital of Xinjiang Medical University from March 2017 to May 2019 were retrospectively analyzed.40 patients with delayed healing after femoral neck fracture surgery were included in delayed healing group，40 patients with good healing were included in the non-delayed healing group.the data of 40 healthy people who received routine physical examination and were confirmed as healthy people in the same period were retrospectively selected as the healthy control group.All the patients received routine examination and laboratory related index examination at admission，and the examination results were complete，the detection results of levels of serum VEGF and VCAM-1 in three groups were mainly recorded at admission.After 4，8 and 12 weeks of surgery，the levels of serum VEGF and VCAM-1 of femoral neck fracture patients were detected and compared.The correlation between serum indexes after at different time after surgery was analyzed.The effect of changes of serum levels in perioperative period on delayed healing after femoral neck fracture surgery was analyzed.The Receiver Operating Characteristic (ROC) curve was used to test the predictive value of serum indexes at different time for delayed healing.Results On admission，the level of serum VEGF in 80 patients with femoral neck fracture was lower than that in control group，and the level of VCAM-1 was higher than that in control group (P＜0.05).The level of VEGF in delayed healing group at different time after surgery was lower than that in non-delayed healing group，and the level of VCAM-1 was higher than that in non-delayed healing group (P＜0.05).The levels of serum VEGF had negative correlation with VCAM-1 in patients with femoral neck fracture 4，8 weeks after surgery (r=0.513，P＜0.05)，and the correlation was the strongest at 4 weeks of surgery.There was no correlation between VEGF and VCAM-1 after 12 weeks of surgery.The results of linear regression analysis showed that the changes of serum VEGF and VCAM-1 levels in perioperative period may be the influencing factors of postoperative delayed healing in patients with femoral neck fracture (P＜0.05).At different time after surgery，the serum VEGF and VCAM-1 levels had certain predictive value for delayed healing after femoral neck fracture surgery (all AUC>0.7，P＜0.05)，and the predictive value was the highest 8 weeks after surgery，and the corresponding areas under the curve were：0.766，0.781.Conclusion The postoperative serum VEGF and VCAM-1 interactions in patients with femoral neck fracture are closely related to postoperative delayed healing，which may be the influencing factor of postoperative delayed healing.The dynamic monitoring of serum VEGF and VCAM-1 levels at different time after surgery can well predict the risk of delayed healing of fracture，guide clinical rational prevention and treatment，and reduce the occurrence of delayed healing.

Key words： femoral neck fracture delayed healing vascular endothelial growth factor vascular cell adhesion molecule-1 correlation

基金资助:新疆维吾尔自治区卫生健康青年医学科技人才专项科研项目(WJWY-202024)

通讯作者: 孙荣鑫

作者简介: 巨啸晨(1985－ )，男，主治医师，新疆医科大学第六附属医院关节一科，830001。

引用本文:

巨啸晨，舒莉，周玲，孙荣鑫 *. 血清VEGF及VCAM-1水平与股骨颈骨折术后延迟愈合的相关性研究[J]. 实用骨科杂志, 2021, 27(2): 131-136.
Ju Xiaochen，Shu Li，Zhou Ling，et al. Research on the Correlation between Serum VEGF and VCAM-1 levels and Delayed Healing after Femoral Neck Fracture Surgery. sygkzz, 2021, 27(2): 131-136.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I2/131

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