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[1]孫偉方,王曄愷,劉曉光,等.血清骨形成蛋白-4水平與異位骨化的關(guān)系研究[J].中醫(yī)正骨,2012,24(06):37-41.
　SUN Wei-fang*,WANG Ye-kai,LIU Xiao-guang,et al.Study on the relationship between serum bone morphogenetic protein-4 levels and heterotopic ossification[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2012,24(06):37-41.
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血清骨形成蛋白-4水平與異位骨化的關(guān)系研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第24卷
期數(shù):
2012年06期
頁碼:
37-41
欄目:
臨床研究
出版日期:
2012-06-30

文章信息/Info

Title:
Study on the relationship between serum bone morphogenetic protein-4 levels and heterotopic ossification
作者:
孫偉方; 王曄愷; 劉曉光; 鄧杰; 顏波兒; 蔣偉亞; 林旭波
浙江省舟山醫(yī)院，浙江舟山316004
Author(s):
SUN Wei-fang*; WANG Ye-kai; LIU Xiao-guang; DENG Jie; YAN Bo-er; JIANG Wei-ya; LIN Xu-bo.*
Zhoushan Hospital,Zhoushan 316004,Zhejiang,China
關(guān)鍵詞:
骨化; 異位性　骨折　顱腦損傷　血清骨形成蛋白－４　治療; 臨床研究性
Keywords:
Ossification; heterotopic; Fractures; bone; Craniocerebral trauma; Bone morphogenetic protein-4;  Therapies; investigational
摘要:
目的：探討血清骨形成蛋白-4水平與異位骨化發(fā)生的關(guān)系，為異位骨化的臨床預(yù)防提供相應(yīng)的理論依據(jù)。方法：選擇2007 年12月至2009年1月入院的外傷患者145例，按創(chuàng)傷類型分為3組：單純腦外傷患者57例，納入A組；單純四肢骨折患者48例，納 入B組；腦外傷合并四肢骨折患者40例，納入C組。入院后根據(jù)患者創(chuàng)傷類型予以治療，并于傷后0.5 d、3 d、15 d、30 d經(jīng)肘 靜脈采血測定患者血清骨形成蛋白-4含量。治療后14～16個(gè)月隨訪時(shí)對患者肩、肘、髖、膝關(guān)節(jié)進(jìn)行X線檢查，然后按患者是否 出現(xiàn)異位骨化分為2組：發(fā)生異位骨化者納入Ⅰ組，未發(fā)生異位骨化者納入Ⅱ組。比較A、B、C組患者的異位骨化發(fā)生情況，并 對各測量時(shí)間點(diǎn)的血清骨形成蛋白-4含量進(jìn)行分析。結(jié)果：①異位骨化發(fā)生情況。145例患者中發(fā)生異位骨化者17例（Ⅰ組）， 未發(fā)生異位骨化者128例（Ⅱ組）；A、B、C組患者異位骨化發(fā)生率比較，差異有統(tǒng)計(jì)學(xué)意義（χ2=8.131，P=0.017）， 進(jìn)一步兩兩比較（調(diào)整檢驗(yàn)水準(zhǔn)：a′=0.017）：A組異位骨化率大于B組（χ2=6.430，P=0.011），其余各組間比較 ，差異無統(tǒng)計(jì)學(xué)意義（A組與C組比較：χ2=3.303，P=0.069；B組與C組比較：χ2=0.044，P=0.834）。②A、B、C 組患者血清骨形成蛋白-4含量。不同時(shí)間點(diǎn)血清骨形成蛋白-4含量不同（F=41.753，P=0.000）：A組0.5 d時(shí)含量與3 d時(shí) 含量比較，差異無統(tǒng)計(jì)學(xué)意義（t=-0.479，P=0.633），15 d時(shí)含量高于3 d和30 d時(shí)含量（t=7.134，P=0.000； t=7.338，P=0.000）；B組各時(shí)間點(diǎn)血清骨形成蛋白-4含量比較，差異無統(tǒng)計(jì)學(xué)意義（F=0.510，P=0.678）；C組0.5 d時(shí) 含量與3 d時(shí)含量比較，差異無統(tǒng)計(jì)學(xué)意義（t=-0.767，P=0.446），15 d時(shí)含量大于3 d和30 d時(shí)含量（t=5.725， P=0.000；t=4.326，P=0.000）。3組間血清骨形成蛋白-4含量總體有差別（F=122.299，P=0.000），進(jìn)一步比較顯示： 0.5 d時(shí)A組含量大于B組和C組（t=5.391，P=0.000；t=5.567，P=0.000）；3 d時(shí)A組含量大于B組和C組（t=4.678， P=0.000；t=3.848，P=0.000）；15 d時(shí)A組含量大于B組和C組（t=12.007，P=0.000；t=6.561，P=0.000），B組含 量小于C組（t=-7.591，P=0.000）；30 d時(shí)A組含量大于B組和C組（t=7.094，P=0.000；t=3.581，P=0.000；）， B組含量小于C組（t=-3.753，P=0.000）。時(shí)間和分組因素存在交互作用（F=18.404，P=0.000）。③Ⅰ、Ⅱ組患者血 清骨形成蛋白-4含量。不同時(shí)間點(diǎn)血清骨形成蛋白-4含量不同（F=40.910，P=0.000）。Ⅰ組0.5 d時(shí)含量與3 d時(shí)含量比較 ，差異無統(tǒng)計(jì)學(xué)意義（t=-0.335，P=0.740），15 d時(shí)含量大于3 d和30 d時(shí)含量（t=4.586，P=0.000；t=3.796，P =0.000）；Ⅱ組0.5 d時(shí)含量小于3 d時(shí)含量（t=-0.898，P=0.000），15 d時(shí)含量大于3 d和30 d時(shí)含量（t=7.106， P=0.000；t=7.750，P=0.000）。2組間血清骨形成蛋白-4含量總體有差別（F=69.398，P=0.000），Ⅰ組各時(shí)間點(diǎn)含量均 高于Ⅱ組（t=5.027，P=0.000；t=3.124，P=0.006；t=5.080，P=0.000；t=6.100，P=0.000）。時(shí)間和分組因素存在 交互作用（F=8.735，P=0.000）。結(jié)論：血清骨形成蛋白-4含量升高可能是腦外傷患者發(fā)生異位骨化的原因之一，適度控 制腦外傷患者傷后血清骨形成蛋白-4含量可能會(huì)降低其異位骨化的發(fā)生率。
Abstract:
Objective:To explore the relationship between serum bone morphogenetic protein-4(BMP-4)levels and the appearance of heterotopic ossification,and to provide the corresponding theoretical basis for clinical prevention of heterotopic ossification.Methods:One hundred and forty-five traumatic patients selected from the patients treated in our hospital from December 2007 to January 2009 were divided into 3 groups according to traumatic types.Fifty-seven patients with traumatic brain injury were included into group A,48 cases with limbs fractures were included into group B,while the others with traumatic brain injury combined with limbs fractures were included into group C.After being hospitalized,patients were treated according to their traumatic types.Serum BMP-4 contents of patients were measured through blood sampling in cubital vein on 0.5 d,3 d,15 d and 30 d postinjury.The shoulder,elbow,hip and knee joints of patients were inspected by X-ray examination when following up 14-16 months later.Then the patients were divided into 2 groups according to the appearance of heterotopic ossification:patients with heterotopic ossification were included into groupⅠ,while the others without heterotopic ossification were included into groupⅡ.The heterotopic ossification occurrences for patients were compared among group A,group B and group C,and the serum BMP-4 contents at all the measuring time points were analyzed.Results:①Occurrences of heterotopic ossification:among the 145 patients,17 cases were found with heterotopic ossification (groupⅠ),while the others were found without heterotopic ossification(groupⅡ).There was statistical difference in occurrences of heterotopic ossification among group A,B&C(χ2=8.131,P=0.017).For the further multiple comparisons(Adjustment of inspection level:a′=0.017):the rate of heterotopic ossification in group A was higher than that in group B(χ2=6.430,P=0.011),while there was no statistical difference between any other groups(group A vs group C:χ2=3.303,P=0.069,group B vs group C:χ2=0.044,P=0.834).②Serum BMP-4 contents in group A,B&C:BMP-4 contents were different at different time points(F=41.753,P=0.000).For group A,there was no statistical difference in contents between 0.5 d and 3 d(t=-0.479,P=0.633),while the content at 15 d was higher than that at 3 d and 30 d respectively (t=7.134,P=0.000;t=7.338,P=0.000).For group B, there was no statistical difference in serum BMP-4 contents among different time points(F=0.510,P=0.678).For group C,there was no statistical difference in contents compared between 0.5 d and 3 d(t=-0.767,P=0.446),while the content at 15 d was higher than that at 3 d and 30 d respectively(t=5.725,P=0.000;t=4.326,P=0.000).There was difference in serum BMP-4 contents among the 3 groups totally(F=122.299,P=0.000).For the further comparision:content of group A was higher than that of group B&C at 0.5 d(t=5.391,P=0.000;t=5.567,P=0.000);so did the contents at 3 d (t=4.678,P=0.000;t=3.848,P=0.000).The serum BMP-4 contents of group A was higher than that of group B&C at 15 d(t=12.007,P=0.000;t=6.561,P=0.000),and content of group B was lower than that of group C(t=-7.591,P =0.000).The content of group A was higher than that of group B&C at 30 d (t=7.094,P=0.000;t=3.581,P=0.000),and content of group B was lower than that of group C(t=- 3.753,P=0.000).There was interaction between time and grouping factors(F=18.404,P=0.000).③Serum BMP-4 contents in groupⅠ&Ⅱ:serum BMP-4 contents were different at different time points(F=40.910,P=0.000).For groupⅠ,there was no statistical difference in contents between 0.5 d and 3 d(t=0.335,P=0.740),while the content at 15 d was higher than that at 3 d and 30 d respectively(t=4.586,P=0.000;t=3.796,P=0.000).For groupⅡ,the content at 0.5 d was lower than that at 3 d(t=-0.898,P=0.000),and content at 15 d was higher than that at 3 d and 30 d respectively(t=7.106,P=0.000;t=7.750,P=0.000).There was difference in serum BMP-4 contents between the 2 groups totally(F=69.398,P=0.000),and the contents of groupⅠat all the time points were all higher than those of groupⅡ (t=5.027,P=0.000;t=3.124,P=0.006;t=5.080,P=0.000;t=6.100,P=0.000).There was interaction between time and grouping factors(F=8.735,P=0.000).Conclusion:Increasing of serum BMP-4 contents may be one of the reasons of occurring heterotopic ossification for patients with traumatic brain injury,therefore,the incidence rate of heterotopic ossification may decrease by controlling of serum BMP-4 contents postinjury properly.

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備注/Memo

備注/Memo:
2010-11-05收稿2012-04-20修回
基金項(xiàng)目：浙江省舟山市衛(wèi)生局醫(yī)藥科研計(jì)劃項(xiàng)目（2009A06）
通訊作者：孫偉方E-mail：[email protected]
更新日期/Last Update: 2012-06-30