标题：关节液 IL-1、NO、CXCL12水平对踝关节骨折内固定术后并发创伤性关节炎的预测价值

      作者：苏晨晨 1，常睿 2，谢斌 3    1.延安市中医医院运动医学科，陕西 延安 716000；2.延安大学附属医院高压氧科，陕西 延安 716000；3.延安市人民医院骨三科，陕西 延安 716000

      卷次： 2023年34卷8期

      【摘要】 目的 探讨关节液白细胞介素 1 (IL-1)、一氧化氮(NO)、趋化因子-12 (CXCL12)水平对踝关节骨折内固定术后并发创伤性关节炎的预测价值。方法 选取2019年1月至2021年1月于延安市中医医院行内固定术治疗的158例踝关节骨折患者为研究对象。所有患者均检测关节液 IL-1、NO、CXCL12水平。术后均随访12个月，根据是否并发创伤性关节炎分为并发组 43例和未并发组 115例；比较两组患者的一般资料和关节液 IL-1、NO、CXCL12水平，采用多因素 Logistic回归分析法分析踝关节骨折内固定术后并发创伤性关节炎的影响因素，且采用受试者工作特征曲线(ROC)分析各关节液指标单独或联合对踝关节骨折内固定术后并发创伤性关节炎的预测价值。结果 158例踝关节骨折患者关节液 IL-1、NO、CXCL12水平分别为 22.36 (19.55，26.30) pg/mL、7.50 (6.08，10.98) μmol/L、4.30 (3.48，6.18) ng/mL；并发组患者的关节液 IL-1、NO、CXCL12水平分别为 28.16(27.26，29.32) pg/mL、11.32 (10.98，12.03) μmol/L、6.85 (6.28，7.32) ng/mL，明显高于未并发组的 20.85 (18.07，23.14) pg/mL、6.53 (5.60，8.04) μmol/L、3.84 (3.20，4.64) ng/mL，差异均有统计学意义(P<0.05)；并发组患者的年龄>65岁、后踝骨折、受伤至手术时间≥7 d占比明显高于未并发组，差异均有统计学意义(P<0.05)；经Logistic回归分析结果显示，年龄>65岁、后踝骨折、受伤至手术时间≥7 d和关节液 IL-1、NO、CXCL12水平高表达均是踝关节骨折内固定术后并发创伤性关节炎的危险因素(P<0.05)；经ROC分析结果显示，关节液 IL-1、NO、CXCL12联合预测踝关节骨折内固定术后并发创伤性关节炎的灵敏度、曲线下面积(AUC)均高于单独预测，差异均有统计学意义(P<0.05)。结论 关节液 IL-1、NO、CXCL12水平升高是踝关节骨折内固定术后并发创伤性关节炎的危险因素，且对内固定术后并发创伤性关节炎具有一定预测价值，但三者联合预测价值更高。
      【关键词】 踝关节骨折；内固定术；创伤性关节炎；白细胞介素1；一氧化氮；趋化因子-12
      【中图分类号】 R683.42 【文献标识码】 A 【文章编号】 1003—6350（2023）08—1134—05

Predictive value of interleukin-1, nitric oxide, and chemokine-12 levels in joint fluid for traumatic arthritis afterinternal fixation of ankle fracture.
SU Chen-chen 1, CHANG Rui 2, XIE Bin 3. 1. Department of Sports Medicine, Yan'anHospital of Traditional Chinese Medicine, Yan'an 716000, Shaanxi, CHINA; 2. Department of Hyperbaric Oxygen, AffiliatedHospital of Yan'an University, Yan'an 716000, Shaanxi, CHINA; 3. Third Department of Orthopaedics, Yan'an People'sHospital, Yan'an 716000, Shaanxi, CHINA
【Abstract】 Objective To investigate the predictive value of interleukin-1 (IL-1), nitric oxide (NO), and che-mokine-12 (CXCL12) levels in articular fluid for traumatic arthritis after internal fixation of ankle fracture. Methods Atotal of 158 patients with ankle fracture who underwent internal fixation in Yan'an Hospital of Traditional Chinese Medi-cine from January 2019 to January 2021 were selected as the research objects. The levels of IL-1, NO, and CXCL12 inarticular fluid were detected in all patients. All patients were followed up for 12 months, and they were divided into con-current group (n=43) and non-concurrent group (n=115) according to whether they were complicated with traumatic ar-thritis. The general data and the levels of IL-1, NO, and CXCL12 in joint fluid between the two groups were compared.Multivariate logistic regression analysis was used to analyze the influencing factors of traumatic arthritis after internalfixation of ankle fracture. The receiver operating characteristic (ROC) curve was used to analyze the predictive value ofeach joint fluid index alone or in combination for traumatic arthritis after internal fixation of ankle fracture. Results Thelevels of IL-1, NO, and CXCL12 in joint fluid of 158 patients with ankle fracture were 22.36 (19.55, 26.30) pg/mL, 7.50(6.08, 10.98) μmol/L, and 4.30 (3.48, 6.18) ng/mL, respectively. The levels of IL-1, NO, and CXCL12 in the joint fluid of theconcurrent group were 28.16 (27.26, 29.32) pg/mL, 11.32 (10.98, 12.03) μmol/L, and 6.85 (6.28, 7.32) ng/mL, respectively,which were significantly higher than 20.85 (18.07, 23.14) pg/mL, 6.53 (5.60, 8.04) μmol/L, and 3.84 (3.20, 4.64) ng/mL ofthe non-concurrent group (P<0.05). The proportions of patients with age>65 years old, posterior ankle fracture, and thetime from injury to operation ≥ 7 d in the concurrent group were significnatly higher than those in the non-concurrentgroup, and the differences were statistically significant (P<0.05). The result of Logistic regression analysis showed thatage>65 years old, posterior ankle fracture, the time from injury to operation ≥7 d and high expression of IL-1, NO andCXCL12 in joint fluid were the risk factors of traumatic arthritis after internal fixation of ankle fracture (P<0.05). TheROC analysis results showed that the sensitivity and area under curve (AUC) of joint fluid IL-1, NO, and CXCL12 in com-bination for predicting traumatic arthritis after internal fixation of ankle fracture were higher than those of the index alone,and the differences were statistically significant (P<0.05). Conclusion The elevated levels of IL-1, NO, and CXCL12 inarticular fluid are the risk factors of traumatic arthritis after internal fixation of ankle fracture, which have a certain predic-tive value for traumatic arthritis after internal fixation, but the predictive value of the three in combination is higher.
      【Key words】 Ankle fracture; Internal fixation; Traumatic arthritis; Interleukin 1; Nitric oxide; Chemokine-12