关键词: 脊柱骨折, 脊髓损伤, 胶质纤维酸性蛋白, 胰岛素样生长因子-1, 临床意义

Abstract: Objective To investigate the relationship between serum levels of glial fibrillar acidic protein (GFAP) and insulin-like growth factor-1 (IGF-1) and neurological function and prognosis in patients with spinal fractures and traumatic spinal cord injury.Methods A total of 92 patients with spinal fractures and traumatic spinal cord injuries from October 2021 to October 2023 were prospectively selected as the observation group and divided into mild,moderate,and severe subgroups based on neurological function.They were also categorized into good and poor prognosis groups.Another 92 patients with only spinal fractures were selected as the control group.Serum GFAP and IGF-1 levels were measured using enzyme-linked immunosorbent assay (ELISA).Forward stepwise multivariable Logistic regression analysis was used to identify prognostic factors,and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance of GFAP and IGF-1 for patient prognosis.Result The GFAP of the control group was (16.86±3.25)μg/L, and the IGF-1 was (146.24±31.47)μg/L, while those of the observation group were (32.57±7.21)μg/L and (97.81±22.43)μg/L, respectively. There was a statistically significant difference between the two groups (P< 0.05 ).These levels were correlated with the severity of neurological injury (mild group:GFAP=22.15±4.75 μg/L,IGF-1=116.27±22.31 μg/L;moderate group:GFAP=36.24±9.64 μg/L,IGF-1=92.14±17.68 μg/L;severe group:GFAP=55.68±13.54 μg/L,IGF-1=51.78±14.64 μg/L,P<0.05).Compared with the good prognosis group (GFAP=26.48±5.86 μg/L,IGF-1=112.23±24.15 μg/L),patients in the poor prognosis group (GFAP=42.05±8.79 μg/L,IGF-1=75.39±15.62 μg/L) exhibited higher GFAP levels and lower IGF-1 levels (P<0.05).Multivariable Logistic regression analysis indicated that Frankel grade,GFAP,and IGF-1 levels were independent risk factors for poor prognosis (Frankel grade OR=2.460,GFAP OR=1.926,IGF-1 OR=0.548,P<0.05).ROC showed that the area under the curve of serum GFAP and IGF-1 combined to predict poor prognosis of patients was 0.983,which was significantly greater than that of single prediction (Z=2.087,2.398,P=0.037,0.016).Conclusion In patients with spinal fractures and traumatic spinal cord injuries,serum GFAP levels are elevated and IGF-1 levels are reduced,which are associated with neurological injury severity.GFAP is a risk factor for poor prognosis,while IGF-1 is a protective factor.

Key words: spinal fracture, spinal cord injury, glial fibrillary acidic protein, insulin like growth factor 1, clinical significance