[1]丁亚军,何金海,纪秉青.血清TGF-β1、Cx43与四肢创伤骨折术后骨不连关系及联合预测价值[J].陕西医学杂志,2026,(3):395-401.[doi:DOI:10.3969/j.issn.1000-7377.2026.03.018]
　DING Yajun,HE Jinhai,JI Bingqing.Relationship between serum TGF-β1,Cx43 and nonunion after limb trauma fracture surgery,and their combined predictive value[J].,2026,(3):395-401.[doi:DOI:10.3969/j.issn.1000-7377.2026.03.018]
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血清TGF-β1、Cx43与四肢创伤骨折术后骨不连关系及联合预测价值

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2026年3期
页码:
395-401
栏目:
临床检验
出版日期:
2026-03-05

文章信息/Info

Title:
Relationship between serum TGF-β1,Cx43 and nonunion after limb trauma fracture surgery,and their combined predictive value
作者:
丁亚军; 何金海; 纪秉青
（南京大学医学院附属盐城第一医院 盐城市第一人民医院骨科，江苏 盐城 220004）
Author(s):
DING Yajun; HE Jinhai; JI Bingqing
(Department of Orthopedics,Yancheng First Hospital Affiliated to Nanjing University Medical School,Yancheng 220004,China)
关键词:
四肢创伤骨折; 骨不连; 转化生长因子-β1; 细胞间隙连接蛋白43; 预测价值
Keywords:
Limbs fractures; Nonunion; Transforming growth factor-β1; Connexin 43; Predictive value
分类号:
R 683.4
DOI:
DOI:10.3969/j.issn.1000-7377.2026.03.018
文献标志码:
A
摘要:
目的：探讨血清转化生长因子-β1（TGF-β1）、细胞间隙连接蛋白43（Cx43）与四肢创伤骨折术后骨不连的关系及联合预测价值。方法：选取四肢创伤骨折患者318例，均行手术治疗，术后随访1年，根据是否发生骨不连分为骨不连组与非骨不连组。比较两组临床资料以及术前、术后1周、术后4周血清TGF-β1、Cx43水平；Logistic回归分析四肢创伤骨折术后骨不连的影响因素；平滑曲线拟合分析血清TGF-β1、Cx43与骨不连的关系；受试者工作特征（ROC）曲线评价血清TGF-β1、Cx43对四肢创伤骨折术后骨不连的预测价值。结果：318例四肢创伤骨折患者术后随访1年，脱落4例，271例患者未发生骨不连，43例患者发生骨不连，发生率为13.69%（43/314）。骨不连组年龄及骨质疏松、固定不稳占比高于非骨不连组，且骨不连组骨折损伤程度较非骨不连组严重（均P＜0.05）。两组术前、术后1周和术后4周血清TGF-β1、Cx43水平呈持续升高趋势（均P＜0.05）。骨不连组术后1周和4周血清TGF-β1、Cx43水平低于非骨不连组（均P＜0.05）。Logistic回归分析显示，年龄、开放性骨折以及术后4周血清TGF-β1、Cx43是四肢创伤骨折术后骨不连的独立影响因素（均P＜0.05）；采用倾向性评分匹配法将年龄、开放性骨折进行平衡处理后，术后4周血清TGF-β1、Cx43仍是四肢创伤骨折术后骨不连的独立影响因素（均P＜0.05）；在校正其他因素后，平滑曲线拟合分析显示，术后4周血清TGF-β1、Cx43与四肢创伤骨折术后骨不连之间呈负向线性关系（均P＜0.05）。ROC曲线分析显示，术后4周血清TGF-β1、Cx43预测四肢创伤骨折术后骨不连的曲线下面积（AUC）为0.767、0.744，敏感度为72.09%、69.77%，特异度为76.75%、72.32%；基于术后4周血清TGF-β1、Cx43构建的联合预测模型的AUC为0.866，敏感度为79.07%，特异度为83.39%，高于单项（均P＜0.05）。结论：血清TGF-β1、Cx43是四肢创伤骨折术后骨不连的独立影响因素，作为独立预测因子时具有良好的预测价值，且联合预测模型价值更高。
Abstract:
Objective:To investigate the relationship between serum transforming growth factor-β1 (TGF-β1),connexin 43 (Cx43) and nonunion after limb trauma fracture surgery,and their combined predictive value.Methods：A total of 318 patients with limb trauma fractures were selected,all of whom underwent surgical treatment.Postoperative follow-up lasted for 1 year.Patients were divided into nonunion group and non-nonunion group based on whether nonunion occurred.The clinical data of the two groups were compared,as well as the levels of serum TGF-β1 and Cx43 before surgery,1 week after surgery,and 4 weeks after surgery.Logistic regression analysis was used to investigate the influencing factors of nonunion after limb trauma fractures surgery.Smooth curve fitting analysis was conducted to explore the relationship between serum TGF-β1,Cx43 and nonunion.ROC curve was used to evaluate the predictive value of serum TGF-β1 and Cx43 for nonunion after limb trauma fractures surgery.Results:After 1-year follow-up of 318 patients with limb trauma fractures,4 cases were lost to follow-up,271 patients had no nonunion,and 43 patients had nonunion,with an incidence of 13.69% (43/314).The age,proportion of osteoporosis and unstable fixation in the nonunion group were higher than those in the non-nonunion group,and the degree of fracture injury was more serious than that in the non-union group (all P<0.05).At preoperation,postoperative 1-week,and postoperative 4-week,the serum levels of TGF-β1 and Cx43 showed a continuous increasing trend in both groups (all P<0.05).At postoperative 1-week and 4-week,the serum levels of TGF-β1 and Cx43 were lower in the nonunion group than those in the non-nonunion group (all P<0.05).Logistic regression analysis indicated that age,open fractures,and serum levels of TGF-β1 and Cx43 at postoperative 4-week were independent factors affecting nonunion after limb trauma fractures surgery (all P<0.05).After balancing age and open fractures using propensity score matching,serum TGF-β1 and Cx43 levels at postoperative 4-week remained independent factors affecting nonunion after limb trauma fractures (all P<0.05).After adjusting for other factors,smooth curve fitting analysis revealed a negative linear relationship between serum TGF-β1,Cx43 at postoperative 4-week and nonunion after limb trauma fractures (P<0.05).ROC curve analysis showed that the AUCs of serum TGF-β1 and Cx43 at postoperative 4-week for predicting nonunion after limb trauma fractures were 0.767 and 0.744,respectively,with sensitivities of 72.09% and 69.77%,and specificities of 76.75% and 72.32%.The AUC of the combined prediction model constructed based on serum TGF-β1 and Cx43 at postoperative 4-week was 0.866,with a sensitivity of 79.07% and a specificity of 83.39%,which was higher than that of the individual indicators (all P<0.05).Conclusion:Serum TGF-β1 and Cx43 are independent influencing factors for nonunion after limb trauma fractures surgery.As independent predictive factors,they have good predictive value,and the combined predictive model has even higher value.

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备注/Memo

备注/Memo:
江苏省优势学科建设工程项目（YSHL2205-312）
更新日期/Last Update: 2026-03-05