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目的探讨术前血清转化生长因子-β1（TGF-β1）、高迁移率族蛋白B1（HMGB1）、NOD样受体热蛋白结构域相关蛋白3（NLRP3）对脊柱骨折合并脊髓损伤（SCI）患者预后的预测价值。方法选取2021年5月～2022年6月在贵州省骨科医院接受手术治疗的脊柱骨折合并SCI患者134例，根据术后12个月预后情况分为预后良好组（83例）、预后不良组（51例）。采用酶联免疫吸附法检测术前血清TGF-β1、HMGB1、NLRP3水平。多因素Logistic回归分析脊柱骨折合并SCI患者预后不良的因素，受试者工作特征（ROC）曲线分析术前血清TGF-β1、HMGB1、NLRP3水平对脊柱骨折合并SCI患者预后不良的预测价值。结果 134例脊柱骨折合并SCI患者术后12个月预后不良发生率为38.06%（51/134）。与预后良好组相比，预后不良组HMGB1、NLRP3更高，TGF-β1更低（P＜0.05）。多因素Logistic回归分析显示糖尿病、受伤至治疗时间≥8h、椎管侵占率≥50%、HMGB1升高、NLRP3升高为脊柱骨折合并SCI患者预后不良的独立危险因素，ASIA分级增加、TGF-β1升高为独立保护因素（P＜0.05）。术前血清TGF-β1、HMGB1、NLRP3联合预测脊柱骨折合并SCI患者预后不良的曲线下面积（AUC）为0.924大于各项指标单独预测。结论术前血清TGF-β1水平降低和HMGB1、NLRP3水平升高与脊柱骨折合并SCI患者预后不良密切相关，术前血清TGF-β1、HMGB1、NLRP3水平联合应用对脊柱骨折合并SCI患者预后不良的预测价值较高。

英文摘要:

Objective To investigate the predictive value of preoperative serum transforming growth factor-β1 (TGF-β1), high mobility group protein B1 (HMGB1) and NOD-like receptor thermal protein domain associated protein 3 (NLRP3) on the prognosis of patients with spinal fracture combine with spinal cord injury (SCI). Methods 134 patients with spinal fracture combine with SCI who underwent surgical treatment in Guizhou Orthopaedic Hospital from May 2021 to June 2022 were selected, patients were divided into good prognosis group (83 cases) and poor prognosis group (51 cases) according to the 12 months prognosis after surgery. The preoperative serum levels of TGF-β1, HMGB1 and NLRP3 were detected by enzyme-linked immunosorbent assay. Multifactorial logistic regression was used to analyze the factors of poor prognosis in patients with spinal fracture combine with SCI, and the predictive value of preoperative serum TGF-β1, HMGB1, and NLRP3 levels in patients with spinal fracture combine with SCI was analyzed by receiver operating characteristics (ROC) curves . Results The incidence of poor prognosis in 134 patients with spinal fracture combine with SCI was 38.06% (51/134) at 12 months after surgery. Compared with good prognosis group, HMGB1 and NLRP3 were higher and TGF-β1 was lower in poor prognosis group (P<0.05).Multivariate logistic regression analysis showed that diabetes, injury to treatment time≥8h, spinal canal encroachment rate≥50%, elevated HMGB1 and elevated NLRP3 were independent risk factors for poor prognosis in patients with spinal fracture combine with SCI, increased ASIA grade and elevated TGF-β1 were independent protective factors (P<0.05). The area under the curve (AUC) of preoperative serum TGF-β1, HMGB1, and NLRP3 combined to predict poor prognosis in patients with spinal fracture combine with SCI was 0.924, which was greater than that predicted by each of the indicators alone (P<0.05). Conclusion The decrease of preoperative serum TGF-β1 level and the increase of HMGB1 and NLRP3 levels are closely relate to the poor prognosis of patients with spinal fracture combine with SCI, the combination of preoperative serum TGF-β1, HMGB1 and NLRP3 levels has a high predictive value for the poor prognosis of patients with spinal fracture combine with SCI.

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