糖化血清蛋白在预测下肢创伤性骨折病人近期预后中的价值

目的:探讨糖化血清蛋白（GSP）在预测下肢创伤性骨折病人近期预后中的价值。方法:选取129例下肢创伤性骨折病人（骨折组），根据病人预后分为2个亚组，有效组104例，无效组25例；另选60名健康志愿者作为对照组。采集3组的血清标本，检测GSP、空腹血糖（FPG）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbA1c）、血清超敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和降钙素原（PCT）水平，Spearman相关系数分析GSP与炎症介质的相关性。以GSP ≥ 400 μmol/L为临界值，将129例病人分为2个亚组，其中GSP ≥ 400 μmol/L组45例，GSP<400 μmol/L组84例，比较2组术后并发症发生率。结果:骨折组GSP水平为（451.4±12.6）μmol/L，明显高于对照组的（159.7±10.8）μmol/L （P<0.01），3项血糖指标亦均高于对照组（P<0.05~P<0.01）。无效组GSP水平为（673.2±24.8）μmol/L，有效组为（299.0±7.1）μmol/L，有效组GSP水平显著低于无效组（P<0.01），HbA1c水平低于无效组（P<0.05），但FPG和2hPG差异均无统计学意义（P>0.05）。有效组和无效组病人炎症介质水平均明显高于对照组（P<0.01）；无效组病人炎症介质水平显著高于有效组（P<0.01）。骨折病人GSP与hs-CRP、TNF-α、IL-6、PCT均呈正相关关系（P<0.05）。GSP ≥ 400 μmol/L组术后并发症发生率为24.44%，明显高于GSP<400 μmol/L组的4.76%（P<0.01）。结论:下肢创伤性骨折病人存在GSP水平的改变，且其改变与IL-6、TNF-α等炎症因子及术后并发症密切相关，对评估预后有一定的临床价值。

The value of glycosylated serum protein in the prediction of the short-term prognosis in patients with traumatic fracture of lower limb

Objective:To investigate the value of glycosylated serum protein (GSP) in the prediction of the short-term prognosis in patients with traumatic fracture of lower limb.Methods:One hundred and twenty-nine patients with traumatic fracture of lower limb (fracture group) were subdivided into the effective group(104 cases) and invalid group(25 cases),and 60 healthy volunteers were set as the control group.The serum levels of the GSP,fasting blood glucose (FPG),2 h postprandial blood glucose (2hPG),glycosylated hemoglobin(HbA1c),high-sensitivity C-reactive protein (hs-CRP),tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6) and procalcitonin (PCT) in three groups were detected.The correlation between GSP and inflammatory mediator was analyzed using Spearman correlation coefficient.According to the critical value of GSP(≥400 μmol/L),129 patients with traumatic fracture of lower limb were divided into the GSP ≥400 μmol/L subgroup(45 cases) and GSP ＜ 400 μmol/L subgroup(84 cases),and the incidence rate of postoperative complications between two groups was compared.Results:The level of GSP in fracture group (451.4 ± 12.6) μmol/L] was significantly higher than that in control group(159.7 ± 10.8) μmol/L] (P ＜0.01),and 3 items of glucose indicators in fracture group were higher than those in control group (P ＜ 0.01).The level of GSP in invalid group (673.2 ± 24.8) μmol/L] was significantly higher than that in effective group(299.0 ± 7.1) μmol/L] (P ＜ 0.01),the level of HbA1c in invalid group was higher than that in effective group(P ＜ 0.01) and the differences of the levels of FPG and 2hPG between two groups were not statistically significant(P ＞ 0.05).The levels of inflammatory mediators in effective group and invalid group were significantly higher than those in control group(P ＜ 0.01),and the level of inflammatory mediators in invalid group was significantly higher than that in effective group (P ＜ 0.01).The level of GSP in fracture patient was positively correlated with the levels of hs-CRP,TNF-α,IL-6 and PCT (P ＜ 0.05).The incidence rate of postoperative complication in GSP≥400 μmol/L group(24.44％) was significantly higher than that in GSP ＜400μmol/L group (4.76 ％) (P ＜ 0.01).Conclusions:The change of GSP level in patients with traumatic fracture of lower limb is found,which is closely related to the levels of IL-6 and TNF-α and postoperative complications,and has certain clinical value in evaluating the prognosis.