临床外科杂志 ›› 2024, Vol. 32 ›› Issue (11): 1200-1204.doi: 10.3969/j.issn.1005-6483.20231736

• 论著 • 上一篇    下一篇

髋部骨折病人血浆线粒体DNA及组织巨噬细胞炎症蛋白1α、单核细胞趋化蛋白-1表达与髋关节功能恢复的关系

  

  1. 271126  济南市第八人民医院创伤关节外科(苏中雷、郭云涛、刘金峰、段元涛、郭新安),心血管内科(王文娟)
  • 收稿日期:2023-12-22 接受日期:2023-12-22 出版日期:2024-11-20 发布日期:2024-11-20
  • 通讯作者: 郭新安,Email:szlwwj@126.com
  • 基金资助:
    济南市卫生健康委员会科技计划项目(2023-2-96)

Relationship between plasma mtDNA,tissue MIP1α,MCP-1 and recovery of hip function in patients with hip fractures

  • Received:2023-12-22 Accepted:2023-12-22 Online:2024-11-20 Published:2024-11-20

摘要: 目的  探讨髋部骨折病人血浆线粒体DNA(mtDNA)及股外侧肌组织巨噬细胞炎症蛋白1α(MIP1α)、单核细胞趋化蛋白1(MCP-1)表达水平与术后肌肉萎缩、髋关节功能恢复的关系。方法  2020年10月~2022年10月行手术治疗的髋部骨折病人86例,为髋部骨折组。同期选择行手术治疗的髋关节炎病人43例作为髋关节炎组。病人均术中留取外侧肌肉组织作为样本。采用实时荧光定量聚合酶链式反应检测血浆mtDNA水平。酶联免疫吸附法检测术前血清中白介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平。免疫荧光法检测术前股外侧肌Ⅰ型、Ⅱ型肌纤维横截面积。蛋白免疫印迹法检测术前外侧肌肉组织MIP1α、MCP-1蛋白水平。髋部骨折病人术后均有效随访6个月,且在3、6个月时,采用DXA测定全身瘦组织质量(TLM)和健肢瘦组织质量(ULLM)。结果  髋部骨折组术前血浆mtDNA水平为(4.12±0.53),高于髋关节炎组的(2.37±0.36),髋部骨折组血清IL-6水平为(34.68±6.14)pg/ml、TNF-α水平为(21.54±4.12)pg/ml,髋关节炎组分别为(12.74±3.06)pg/ml、(10.81±2.71)pg/ml,髋部骨折组外侧肌肉组织Ⅰ型肌纤维为(4321.45±441.36)μm2,Ⅱ型肌纤维横截面积为(2384.38±247.11)μm2,髋关节炎组分别为(5417.63±553.27)μm2、(3569.24±368.22)μm2,髋部骨折组MIP1α蛋白水平为2.34±0.25、MCP-1蛋白水平为2.47±0.28,髋关节炎组分别为1.18±0.15、1.95±0.23,两组比较差异有统计学意义(P<0.05)。髋部骨折病人术后随访6个月后,预后良好53例,预后不良33例。预后不良组术前血浆mtDNA为4.53±0.52,高于预后良好组的(3.87±0.44),预后不良组血清IL6水平为(35.97±5.32)pg/ml、TNF-α水平为(22.83±4.33)pg/ml,预后良好组分别为(33.51±5.16)pg/ml、(20.74±4.27)pg/ml,预后不良组外侧肌肉组织Ⅰ型肌纤维面积为(4174.26±434.60)μm2,Ⅱ〖JP2〗型肌纤维横截面积为(2309.56±246.18)μm2,预后良好组分别为(4394.42±450.12)μm2、(2430.97±250.72)μm2,预后不良组MIP1α蛋白水平为2.47±0.28,MCP-1蛋白水平为1.95±0.23,预后良好组分别为2.26±0.24、1.82±0.21,两组比较差异有统计学意义(P<0.05)。预后良好组和预后不良组髋关节骨折病人术后6个月 TLM和ULLM均小于术后3个月(P<0.05),但术后3、6个月两组TLM和ULLM比较,差异无统计学意义(P>0.05)。结论 老年髋部骨折病人后发生创伤应激损伤,促使血浆mtDNA水平升高,进而诱导血清IL-6和TNF-α以及MCP-1、MIP1α炎症因子

关键词: 髋部骨折, 线粒体DNA, 巨噬细胞炎症蛋白1α, 单核细胞趋化蛋白1, 肌肉萎缩, 髋关节功能

Abstract: Objective  To analyze the relationship between plasma mitochondrial DNA(mtDNA),macrophage inflammatory protein-1α(MIP1α) and monocyte chemotactic protein 1(MCP-1) in vastus lateralis tissues and postoperative muscle atrophy,recovery of hip function in patients with hip fractures.Methods A total of 86 patients with hip fractures and 43 patients with coxitis in Jinan Eighth People’s Hospital were enrolled as hip fracture group and coxitis group between October 2020 and October 2022,respectively.The lateral muscle tissues were collected as samples during surgery.The level of plasma mtDNA was detected by real-time fluorescence quantitative polymerase chain reaction.Before surgery,levels of serum interleukin-6(IL-6) and tumor necrosis factor α(TNF-α) were detected by enzyme-linked immunosorbent assay.Before surgery,cross-sectional areas of types I and II vastus lateralis fibers were detected by immunofluorescence method.Before surgery,expression levels of MIP1α and MCP-1 proteins in lateral muscle tissues were detected by Western blot.All patients with hip fracture were effectively followed up for 6 months after surgery.At 3 and 6 months after surgery,total lean mass(TLM) and unaffected limb lean mass(ULLM) were detected by DXA.Results  The level of plasma mtDNA in hip fracture group was higher than that in coxitis group before surgery [(4.12±0.53) vs(2.37±0.36),P<0.05],levels of serum IL-6 and TNF-α were higher than those in coxitis group [(34.68±6.14)pg/ml,(21.54±4.12)pg/ml vs(12.74±3.06)pg/ml,(10.81±2.71)pg/ml,P<0.05],cross-sectional areas of types I and II vastus lateralis fibers were smaller than those in coxitis group [(4321.45±441.36) μm2,(2384.38±247.11) μm2 vs(5417.63±553.27) μm2,(3569.24±368.22) μm2,P<0.05],and expression levels of MIP1α and MCP-1 proteins were higher than those in coxitis group [(2.34±0.25),(2.47±0.28) vs(1.18±0.15),(1.95±0.23),P<0.05].In patients with hip fracture after 6 months of follow-up,there were 53 cases with good prognosis and 33 cases with poor prognosis.The level of plasma mtDNA in poor prognosis group was higher than that in good prognosis group before surgery [(4.53±0.52) vs(3.87±0.44),P<0.05],levels of serum IL-6 and TNF-α were higher than those in good prognosis group [(35.97±5.32)pg/ml,(20.74±4.27)pg/ml vs(33.51±5.16)pg/ml,(22.83±4.33)pg/ml,P<0.05],cross-sectional areas of types I and II vastus lateralis fibers were smaller than those in good prognosis group [(4174.26±434.60) μm2,(2309.56±246.18) μm2 vs(4394.42±450.12) μm-2,(2430.97±250.72) μm-2,P<0.05],and expression levels of MIP1α and MCP-1 proteins were higher than those in good prognosis group [(2.47±0.28),(1.95±0.23) vs(2.26±0.24),(1.82±0.21),P<0.05].TLM and ULLM at 6 months after surgery were lower than those at 3 months after surgery in good prognosis group and poor prognosis group(P<0.05).At 3 and 6 months after surgery,there was no significant different in TLM or ULLM between good prognosis group and poor prognosis group(P>0.05).Conclusion  Traumatic stress injury will increase level of plasma mtDNA in patients with hip fracture,which will induce the increase of systemic inflammatory indexes(serum IL-6,TNF-α) and inflammatory factors(MCP-1,MIP1α) levels,aggravate muscle atrophy and cause postoperative decline of hip function.

Key words: hip fracture, mitochondrial DNA, macrophage inflammatory protein 1α, monocyte chemotactic protein 1, muscle atrophy, hip function

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