[1]肖伟平,周定凯,柳百炼,等.血清自噬标志物水平与脊柱骨折合并急性脊髓损伤的关系研究[J].中医正骨,2026,38(03):30-34,51.
　XIAO Weiping,ZHOU Dingkai,LIU Bailian,et al.Study on the relationship between serum autophagy marker levels and spinal fractures complicated with acute spinal cord injury[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2026,38(03):30-34,51.
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血清自噬标志物水平与脊柱骨折合并急性脊髓损伤的关系研究()

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第38卷
期数:
2026年03期
页码:
30-34,51
栏目:
临床研究
出版日期:
2026-03-20

文章信息/Info

Title:
Study on the relationship between serum autophagy marker levels and spinal fractures complicated with acute spinal cord injury
作者:
肖伟平1; 周定凯2; 柳百炼1; 王大兴1; 陈卓远1
(1.昆明市延安医院,云南 昆明 650051; 2.禄劝彝族苗族自治县第一人民医院,云南 禄劝 651500)
Author(s):
XIAO Weiping1; ZHOU Dingkai2; LIU Bailian1; WANG Daxing1; CHEN Zhuoyuan1
1.Yan'an Hospital of Kunming city,Kunming 650051,Yunnan,China; 2.The First People's Hospital of Luquan Yi and Miao Autonomous County,Luquan 651500,Yunnan,China
关键词:
脊髓损伤;  脊柱骨折;  自噬;  Beclin-1;  自噬相关蛋白5;  自噬相关蛋白7;  生物标志物;  预后
Keywords:
spinal cord injuries;  spinal fractures;  autophagy;  Beclin-1;  autophagy-related protein 5;  autophagy-related protein 7;  biomarkers;  prognosis
摘要:
目的:分析血清Beclin-1、自噬相关蛋白(autophagy-related protein,ATG)5、ATG7水平与脊柱骨折合并急性脊髓损伤(spinal cord injury,SCI)的关系。方法:选择2018年2月至2022年12月收治的264例脊柱骨折患者,其中108例合并急性SCI(SCI组)、156例未合并急性SCI(非SCI组),另外选择100例同期在医院体检健康者(健康对照组)。入院或体检时采集静脉血,采用ELISA技术检测3组受试者的血清Beclin-1、ATG5、ATG7水平。根据伤后12个月时的日本骨科学会腰痛评估量表评分改善率,判定SCI组的预后情况(改善率<50%为预后不良,改善率≥50%为预后良好); 通过比较SCI组不同预后患者的年龄、性别、合并糖尿病情况、合并高血压病情况、受伤原因、受伤至就诊时间、Frankel分级、脊柱损伤节段、脊髓水肿或出血情况、血清自噬标志物(Beclin-1、ATG5、ATG7)水平及治疗方式,进行脊柱骨折合并急性SCI预后影响因素的单因素筛选。在此基础上,通过多因素Logistic回归分析,分析血清Beclin-1、ATG5、ATG7水平与脊柱骨折合并急性SCI预后的关系,并采用受试者操作特征(receiver operating characteristic,ROC)曲线评价以血清Beclin-1、ATG5、ATG7水平判断脊柱骨折合并急性SCI预后的价值。结果:①3组受试者血清自噬标志物水平比较结果。SCI组和非SCI组患者的血清Beclin-1、ATG5、ATG7水平均高于健康对照组(P=0.000,P=0.000; P=0.000,P=0.000; P=0.000,P=0.000),SCI组的血清Beclin-1、ATG5、ATG7水平均高于非SCI组(P=0.000,P=0.000,P=0.000)。②脊柱骨折合并急性SCI预后影响因素的单因素筛选结果。伤后12个月时,SCI组预后良好患者72例、预后不良患者36例。预后良好和预后不良患者Frankel分级、脊髓水肿或出血情况及血清Beclin-1、ATG5、ATG7水平的组间差异均有统计学意义(χ2=30.397,P=0.000; χ2=26.912,P=0.000; t=11.758,P=0.000; t=8.112,P=0.000; t=8.558,P=0.000),年龄、性别、合并糖尿病情况、合并高血压病情况、受伤原因、受伤至就诊时间、脊柱损伤节段及治疗方式的组间差异均无统计学意义。③血清自噬标志物水平与脊柱骨折合并急性SCI预后关系的多因素Logistic回归分析结果。以Frankel分级、脊髓水肿或出血情况及血清Beclin-1、ATG5、ATG7水平为自变量,以脊柱骨折合并急性SCI预后情况为因变量,进行多因素Logistic回归分析。结果显示,血清Beclin-1、ATG5、ATG7水平升高均为脊柱骨折合并急性SCI预后良好的独立保护因素[B=-0.588,P=0.002,OR=0.555(0.285,0.732); B=-0.742,P=0.042,OR=0.476(0.229,0.962); B=-1.152,P=0.026,OR=0.316(0.144,0.904)]。④血清自噬标志物水平判断脊柱骨折合并急性SCI预后的ROC曲线分析结果。血清Beclin-1、ATG5、ATG7水平单独及三者联合均对判断脊柱骨折合并急性SCI预后具有一定价值, 对应曲线下面积分别为0.950、0.914、0.927、0.978,且三者联合判断的曲线下面积大于三者单独判断(Z=3.852,P=0.025; Z=4.774,P=0.011; Z=4.321,P=0.016)。结论:脊柱骨折合并急性SCI患者的血清Beclin-1、ATG5、ATG7水平升高; 血清Beclin-1、ATG5、ATG7水平升高均为脊柱骨折合并急性SCI预后良好的独立保护因素,可作为判断其预后的血清生物学标志物。
Abstract:
Objective:To analyze the relationship between serum Beclin-1,autophagy-related protein(ATG)5,ATG7 levels and spinal fractures complicated with acute spinal cord injury(SCI).Methods:A total of 264 patients with spinal fractures admitted from February 2018 to December 2022 were selected,including 108 cases complicated with acute SCI(SCI group)and 156 cases without acute SCI(non-SCI group).Additionally,100 healthy individuals who underwent physical examinations at the hospital during the same period were selected as the healthy control group.Venous blood was collected upon admission or physical examination,and serum Beclin-1,ATG5,and ATG7 levels in the three groups were detected using ELISA technology.The prognosis of the patients in SCI group was determined at 12 months after injury based on the improvement rate of the Japanese Orthopedic Association back pain evaluation questionnaire score(poor prognosis:improvement rate <50%; good prognosis:improvement rate≥50%).Univariate analysis was performed to identify factors influencing prognosis in patients with spinal fractures complicated with acute SCI by comparing age,gender,comorbid diabetes mellitus status,comorbid hypertension status,cause of injury,time from injury to consultation,Frankel grade,spinal injury segment,spinal cord edema or hemorrhage status,serum autophagy marker(Beclin-1,ATG5,ATG7)levels,and treatment methods among patients with different prognoses in the SCI group,based on which,the relationship between serum Beclin-1,ATG5,ATG7 levels and the prognosis of spinal fractures complicated with acute SCI was analyzed through multivariate logistic regression analysis,and the value of serum Beclin-1,ATG5,ATG7 levels in predicting the prognosis of spinal fractures complicated with acute SCI was evaluated using receiver operating characteristic(ROC)curves.Results:①Comparison results of serum autophagy marker levels among the three groups.The serum Beclin-1,ATG5,and ATG7 levels in the SCI group and the non-SCI group were all higher than those in the healthy control group(P=0.000,P=0.000; P=0.000,P=0.000; P=0.000,P=0.000),and the serum Beclin-1,ATG5,and ATG7 levels in the SCI group were all higher than those in the non-SCI group(P=0.000,P=0.000,P=0.000).②Univariate screening results of prognostic influencing factors for spinal fractures complicated with acute SCI.At 12 months after injury,72 patients in the SCI group exhibited a good prognosis,and 36 ones showed a poor prognosis.The differences in Frankel grade,spinal cord edema or hemorrhage status,and serum Beclin-1,ATG5,ATG7 levels between patients with good prognosis and those with poor prognosis were statistically significant(χ2=30.397,P=0.000; χ2=26.912,P=0.000; t=11.758,P=0.000; t=8.112,P=0.000; t=8.558,P=0.000),while the differences in age,gender,comorbid diabetes mellitus status,comorbid hypertension status,cause of injury,time from injury to consultation,spinal injury segment,and treatment method were not statistically significant.③Multivariate logistic regression analysis results of the relationship between serum autophagy marker levels and the prognosis of spinal fractures complicated with acute SCI.Taking Frankel grade,spinal cord edema or hemorrhage status,and serum Beclin-1,ATG5,ATG7 levels as independent variables,and the prognosis of spinal fractures complicated with acute SCI as the dependent variable,multivariate logistic regression analysis was performed.The results showed that elevated serum Beclin-1,ATG5,and ATG7 levels were all independent protective factors for good prognosis of spinal fractures complicated with acute SCI(B=-0.588,P=0.002,OR=0.555(0.285,0.732); B=-0.742,P=0.042,OR=0.476(0.229,0.962); B=-1.152,P=0.026,OR=0.316(0.144,0.904)).④ROC curve analysis results of serum autophagy marker levels for predicting the prognosis of spinal fractures complicated with acute SCI.Serum Beclin-1,ATG5,and ATG7 levels alone and their combination all had certain value in predicting the prognosis of spinal fractures complicated with acute SCI,the area under the curve is 0.950、0.914、0.927、0.978,respectively,and the area under the curve of the combined prediction was greater than that of each marker alone(Z=3.852,P=0.025; Z=4.774,P=0.011; Z=4.321,P=0.016).Conclusion:Serum Beclin-1,ATG5,and ATG7 levels are elevated in patients with spinal fractures complicated with acute SCI; elevated serum Beclin-1,ATG5,and ATG7 levels are independent protective factors for good prognosis of spinal fractures complicated with acute SCI and can serve as serum biomarkers for predicting prognosis in these patients.

参考文献/References:

[1] LI T T,WEI Y,ZHOU H S,et al.The difference of disease injury and postoperative recovery in the occupational characteristics of thoracolumbar fracture patients:a retrospective study[J].Orthop Surg,2022,14(9):2059-2072.
[2] JAIN M,MOHANTY C R,DOKI S K,et al.Traumatic spine injuries in eastern india:a retrospective observational study[J].Int J Crit Illn Inj Sci,2021,11(2):79-85.
[3] HU X,XU Y,ZHANG H,et al.Role of necroptosis in traumatic brain and spinal cord injuries[J].J Adv Res,2022,40:125-134.
[4] HE X,LI Y,DENG B,et al.The PI3K/AKT signalling pathway in inflammation,cell death and glial scar formation after traumatic spinal cord injury:mechanisms and therapeutic opportunities[J].Cell Prolif,2022,55(9):e13275.
[5] GUO R,WANG H,CUI N.Autophagy regulation on pyro-ptosis:mechanism and medical implication in sepsis[J].Mediators Inflamm,2021,2021:9925059.
[6] GAO Y,LIU J,LI K,et al.Metformin alleviates sepsis-associated myocardial injury by enhancing AMP-activated protein kinase/mammalian target of rapamycin signaling pathway-mediated autophagy[J].J Cardiovasc Pharmacol,2023,82(4):308-317.
[7] ZHANG X,WEI M,FAN J,et al.Ischemia-induced upregulation of autophagy preludes dysfunctional lysosomal storage and associated synaptic impairments in neurons[J].Autophagy,2021,17(6):1519-1542.
[8] HAO J,YANG Y,XIE L,et al.Actl6a regulates autophagy via Sox2-dependent Atg5 and Atg7 expression to inhibit apoptosis in spinal cord injury[J].J Adv Res,2025,77:281-296.
[9] YANG S,GU W,MA Z,et al.Dl-3-n-Butylphthalide inhibits autophagy to alleviate the neuronal apoptosis after spinal cord injury by elevating YAP via inactivating the hippo signaling pathway[J].Chem Biol Drug Des,2025,106(4):e70180.
[10] ZHOU A F,LI Z Y,CUI X J,et al.Cross-cultural adaptation of the Japanese orthopaedic association back pain evaluation questionnaire:a methodological systematic review[J].J Orthop Sci,2023,28(5):984-991.
[11] 张言旭,战世强,张正阳,等.微RNA-301a-3p、微RNA-146a-5p、微RNA-142-5p水平对脊柱骨折伴脊髓损伤预后不良的预测价值[J].脊柱外科杂志,2025,23(6):382-386.
[12] 杜媛媛,杨好,陈程程,等.脊柱骨折伴急性脊髓损伤NOD样受体蛋白3炎症小体及相关因子变化及其与预后的相关性[J].中国骨伤,2024,37(7):684-688.
[13] FREYERMUTH-TRUJILLO X,SEGURA-URIBE J J,SALGADO-CEBALLOS H,et al.Inflammation:a target for treatment in spinal cord injury[J].Cells,2022,11(17):2692.
[14] DIPIRO N D,MURDAY D,CORLEY E H,et al.The primary and secondary causes of hospitalizations during the first five years after spinal cord injury[J].Spinal Cord,2022,60(6):574-579.
[15] ZHANG M,CHEN L,GAO H,et al.Lamotrigine enhances autophagy and reduces post-traumatic spinal neural injury in mice[J].J Integr Neurosci,2025,24(5):37357.
[16] CHEN G,SHANGGUAN Z,YE X,et al.STM2457 inhibits METTL3-mediated m6a modification of miR-30c to alleviate spinal cord injury by inducing the ATG5-mediated autophagy[J].Neurospine,2024,21(3):925-941.
[17] XIAO J,TU B,ZHOU X,et al.Autophagy deficiency exacerbates acute lung injury induced by copper oxide nanoparticles[J].J Nanobiotechnology,2021,19(1):162.
[18] VARGOVA I,MACHOVA URDZIKOVA L,KAROVA K,et al.Involvement of mTOR pathways in recovery from spinal cord injury by modulation of autophagy and immune response[J].Biomedicines,2021,9(6):593.
[19] 米爽,吴燕君,洪正华,等.TLR4/MyD88/NF-κB通路基因及相关炎症因子在继发性脊髓损伤患者中的表达[J].浙江大学学报(医学版),2019,48(6):609-616.
[20] 余东洋,何少波,唐忠秋.中性粒细胞与淋巴细胞比值及纤维蛋白原水平对创伤性脊柱骨折合并脊髓损伤临床预后的预测价值[J].国际检验医学杂志,2022,43(20):2506-2509.

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备注/Memo

备注/Memo:
基金项目:2025年度昆明市卫生科研课题(2025-04-07-007)
通信作者:陈卓远 E-mail:chenzhuoyuan2010@163.com
(收稿日期:2025-05-21 本文编辑:李晓乐)
更新日期/Last Update: 2026-03-20