脊柱骨折并发脊髓损伤患者血清miRNA-133a和核苷酸结合寡聚化结构域样受体蛋白3表达水平及其与预后的相关性研究

目的 探究脊柱骨折并发脊髓损伤（spinal cord injury,SCI）患者血清微小RNA(microRNA,miR)-133a和核苷酸结合寡聚化结构域样受体蛋白3(nucleotide-binding oligomerization domain-like receptors protein 3,NLRP3)表达水平及其与预后的关系。方法 选取2019年1月～2022年3月在贵州省骨科医院治疗的90例脊柱骨折并发SCI患者作为并发SCI组，统计手术后3个月患者预后情况，并依据预后分为预后良好组和预后不良组；另以同期单纯脊柱骨折患者90例作为对照组，记录患者一般资料。采用酶联免疫吸附试验（enzyme-linked immunosorbent assay,ELISA）检测脊柱骨折患者血清NLRP3水平，采用实时荧光定量PCR(quantitative real-time PCR,qRT-PCR)法检测miR-133a水平；受试者工作特征（receiver operating characteristic,ROC）曲线分析血清miR-133a和NLRP3水平预测脊柱骨折并发SCI患...

Expression Levels of miRNA-133a,Nucleotide Binding Oligomerization Domain-like Receptor Protein 3 in Serum of Patients with Spinal Fracture Complicated with Spinal Cord Injury and Their Correlation with Prognosis

Objective To explore the expression levels of micro RNA(miR)-133a and nucleotide-binding oligomerization domain-like receptor 3 (NLRP3) in serum of patients with spinal cord injury(SCI) complicated spinal fracture and its relationship with prognosis. Methods A total of 90 patients with spinal fractures combined with SCI who were treated in Guizhou Provincal Orthopedics Hospital from January 2019 to March 2022 were selected as the combined SCI group. The prognosis of the patients 3 months after the operation was counted. They were divided into a good prognosis group and a poor prognosis group according to the prognosis. In addition, 90 patients with simple spinal fracture during the same period were selected as the control group, and the general data of the patients were recorded. The level of serum NLRP3 in patients with spinal fractures was detected by enzyme-linked immunosorbent assay (ELISA), and the level of miR-133a was detected by quantitative real-time PCR (qRT-PCR) method. Receiver operating characteristic (ROC) curve was drawn to analyze the value of serum miR-133a and NLRP3 levels in predicting the prognosis of patients with spinal fractures complicated with SCI, and multivariate Logistic regression was used to analyze the influencing factors of poor prognosis in patients with spinal fractures complicated with SCI. Results Compared with the control group, the serum miR-133a level in the SCI group was decreased (0.68±0.19 vs 1.01±0.24), and the NLRP3 level was increased (136.42±32.78 pg/ml vs 86.35±15.95 pg/ml), and the difference was statistically significant (t=10.227, 13.030, all P<0.001). Compared with the group with good prognosis, the spinal canal invasion rate ≥ 50% (64.71% vs 23.21%), duration of hormone drug use ≥ 8 h from injury (70.59% vs 25.00%), Frankel grade A (41.18% vs 1.79%), the serum NLRP3 levelin the poor prognosis groupwere increased (162.11±46.74 pg/ml vs 120.82±29.75 pg/ml), and the miR-133a level in the poor prognosis groupwas decreased (0.58±0.14 vs 0.74±0.18), and the differences were statistically significant (t=4.430~45.267, all P<0.001). ROC analysis showed that the area under the curve (AUC) of serum miR-133a, NLRP3 and their combination in predicting poor prognosis in patients with spinal fractures and SCI were 0.779 (95%CI:0.681~0.877) and 0.770 (95%CI:0.673~0.868), 0.834 (95%CI:0.750~0.918).The results of Logistic regression showed that miR-133aOR(95%CI)=0.824(0.727~0.934)], NLRP3OR (95%CI) =2.673 (1.359~5.256) ], spinal canal invasion rate ≥ 50%OR(95%CI)=1.562(1.146~2.129) ], and the time from injury to hormone use ≥ 8 h OR(95%CI)=1.305(1.009~1.687)] were independent influencing factors for poor prognosis in patients with spinal fractures complicated with SCI(all P<0.05). Conclusion Serum NLRP3 levels were higher and miR-133a levels were lower in patients with spinal fractures combined with SCI, which were closely related to prognosis. The combination of the two have high predictive performance on the prognosis of patients with spinal fractures combined with SCI.