术前髋部骨折类型及严重程度与细胞因子及C反应蛋白的相关性研究

Serum cytokines and CRP levels in different types and severity of hip fractures

关键词:  细胞因子  髋部骨折  C反应蛋白  股骨颈骨折  股骨转子间骨折

Key words:  cytokines  hip fractures  C-reactive protein  femoral neck fracture  intertrochanteric fracture

摘要:

目的 评估外周血细胞因子和C反应蛋白（C-reactive protein, CRP）表达水平与不同髋部骨折类型的相关性。方法 根据髋部骨折患者的纳入和排除标准，从2020年9月—2023年7月连续招募了278例患者。依据股骨颈骨折的Garden分型和股骨转子间骨折的OA/OTA分型，将患者分为比较严重（Garden Ⅰ和Garden Ⅱ；31A1）和严重（Garden Ⅲ和Garden Ⅳ；31A2，31A3）两个骨折组。检测和收集了血清细胞因子和CRP的表达水平。结果 严重骨折组血清IL-6、IL-8、IL-10、TNF-α明显高于比较严重骨折组（P<0.05）。对于不同类型的骨折，股骨转子间骨折组血清IL-6、CRP显著高于股骨颈骨折组（P<0.05），尽管股骨转子间骨折组血清IL-8、IL-10、TNF-α高于股骨颈骨折组，但无差异。调整身高、体重、体重指数干扰因素后，严重骨折的血清IL-6、IL-8、CRP水平显著升高（P＜0.05），特别是血清IL-6、IL-8在股骨转子间骨折患者中（P=0.00）。结论 IL-6、IL-8、IL-10和TNF-α的表达水平与髋部骨折的严重程度呈正相关，而髋部骨折的类型仅与CRP和IL-6的表达水平相关。

Abstract:

Objective To investigate serum cytokine and C-reactive protein(CRP) levels in different types and severity of hip fractures. Methods A total of 278 consecutive patients with hip fractures were recruited from September 2020 to July 2023, including 151 cases of hip neck fractures and 127 cases of intertrochanteric fractures. Patients were categorized into less severe and severe fracture groups based on the Garden classification for femoral neck fractures and the AO/OTA classification for intertrochanteric fractures. Serum cytokine and CRP expression levels were tested for all patients. Results Serum levels of IL-6, IL-8, IL-10, and TNF-α were significantly higher in the severe fracture group compared to the less severe fracture group(P<0.05). For different types of fractures, serum levels of IL-6 and CRP were significantly higher in the intertrochanteric fracture group compared to the femoral neck fracture group(P<0.05), while there were no significant differences in serum IL-8, IL-10, and TNF-α levels between patients with intertrochanteric fractures and those with femoral neck fractures. After adjusting for height, weight, and BMI, serum levels of IL-6, IL-8, and CRP were significantly elevated in the severe fracture group(P<0.05), particularly for IL-6 and IL-8 in the intertrochanteric fracture patients(P=0.00). Conclusion The elevation of serum IL-6, IL-8, IL-10 and TNF-α levels are associated with the severity of hip fractures, while the CRP and IL-6 levels in patients with intertrochanteric fractures are higher than those with hip neck fractures.