骨纤维异常增殖症患者血清骨膜素水平与骨畸形进展的关系

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摘要目的骨纤维异常增殖症(fibrous dysplasia，FD)是一种罕见的良性骨骼进行性疾病，常因“牧羊杖”畸形进展而复杂化。本研究旨在分析FD患者血清骨膜素(periostin，PN)水平与骨畸形进展的关系。方法 2011年1月至2018年9月在保定市第二医院骨科共招募了159例FD患者，其中男49例，女110例；年龄5~58岁，平均(28.16±20.08)岁；127例单骨型FD，32例多骨型FD。分别于术前24 h和术后7 d采集血清样本。另外纳入200例健康志愿者作为对照组，其中男70例，女130例；年龄5~55岁，平均(25.44±17.32)岁，采集血清样本。采用夹心酶联免疫吸附试验检测两组血清PN水平。应用单因素和多因素COX回归分析来确定发生“牧羊杖”畸形的危险因素。结果 FD组患者术前血清PN水平显著高于对照组(P＜0.05)。在单因素分析中，年龄、病变部位、病变类型、“牧羊杖”骨畸形进展与术前血清PN水平密切相关(P＜0.05)。经单因素和多因素分析，多骨型FD(OR：4.592，95%CI：1.610～13.102，P＝0.004)和术前血清PN水平异常升高(OR：6.596，95%CI：2.177～19.983，P＝0.001)是发生“牧羊杖”骨畸形的独立危险因素(P＜0.05)。经整体分析，FD组患者术后血清PN水平与术前相比明显降低(P＝0.005)。经亚组分析，发生骨畸形进展和无骨畸形进展的FD患者血清PN水平随时间变化趋势存在统计学差异(P＜0.05)，发生骨畸形进展的患者术后血清PN水平高于无骨畸形进展的FD患者(P＜0.05)。结论血清PN水平较高的多骨型FD患者有明显的骨畸形进展趋势，监测血清PN有助于预测“牧羊杖”骨畸形进展。

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	陈美玲
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关键词 ：骨纤维异常增殖症, 手术, 血清骨膜素, &ldquo, 牧羊杖&rdquo, 畸形

Abstract：Objective Fibrous dysplasia (FD) is a rare benign progressive disease of bone，which is often complicated by the progression of Shepherd’s crook deformity.The aim of this study was to analyze the relationship between serum Periostin (PN) and the progression of bone deformities in FD patients.Methods From January 2011 to September 2018，159 FD patients were collected in the Department of Orthopaedics of Baoding Second Hospital，including 49 males and 110 females.The average age was (28.16±20.08) years，ranging from 5 to 58 years.There were 127 cases of single bone FD and 32 cases of multiple bone FD.Serum samples were collected 24 hours before operation and 7 days after operation.In addition，200 healthy volunteers were included as the control group，including 70 males and 130 females.The average age was (25.44±17.32) years.Serum samples were collected.Sandwich enzyme linked immunosorbent assay was used to detect the serum PN levels in the two groups.Univariate and multivariate COX regression analysis was used to determine the risk factors of Shepherd’s crook deformity.Results The serum PN level in FD group was significantly higher than that in control group (P＜0.05).In univariate factor analysis，age，lesion location，lesion type，the progress of Shepherd’s crook deformity were closely related to serum PN level before operation (P＜0.05).By univariate and multivariate factor analysis，multiple Bone FD (OR：4.592，95% CI：1.610～13.102，P＝0.004) and abnormal serum PN (OR：6.596，95% CI：2.177～19.983，P＝0.001) were the independent risk factors for the occurrence of Shepherd’s crook deformity (P＜0.05).The overall analysis showed that the serum PN level after operation in FD group was lower than that before operation (P＝0.005).There was a significant difference in the trend of serum PN levels between FD patients with and without bone deformity(P＜0.05)，the postoperative serum PN level of patients with bone malformation progression was also higher than that of FD patients without bone malformation progression (P＜0.05).Conclusion The multiple bone FD patients with higher serum PN levels have a clear trend of bone deformity progression.Monitoring serum PN is helpful to predict the progression of Shepherd’s crook deformity.

Key words： fibrous dysplasia surgery serum periostin shepherd’s crook deformity

基金资助:河北省中医药管理局科研计划项目(2017310)

作者简介: 陈美玲(1980－ )，女，主治医师，保定市第二医院骨科，chen_xiaochen216@sina.com

引用本文:

陈美玲，崔亚楠，胥倩. 骨纤维异常增殖症患者血清骨膜素水平与骨畸形进展的关系[J]. 实用骨科杂志, 2023, 29(2): 126-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I2/126

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