血清miR-203a、miR-31-5p、miR-19b-1-5p水平与股骨颈骨折患者骨折延迟愈合的关系及其预测价值分析

摘要 目的：探讨血清微小核糖核酸（miR）-203a、miR-31-5p、miR-19b-1-5p水平与股骨颈骨折患者术后骨折延迟愈合的关系及对术后骨折延迟愈合的预测价值。方法：选择2020年1月~2022年10月在徐州医科大学附属医院行内固定治疗的292例新鲜股骨颈骨折患者为研究对象。于术后4周复查时，检测患者血清miR-203a、miR-31-5p、miR-19b-1-5p水平；并根据其骨折愈合情况分为延迟组（n=36）和愈合组（n=256）。采用多因素Logistic回归分析股骨颈骨折患者术后骨折延迟愈合的影响因素。采用受试者工作特征（ROC）曲线分析血清miR-203a、miR-31-5p、miR-19b-1-5p对股骨颈骨折患者术后骨折延迟愈合的预测价值。结果：术后4个月复查时，骨折延迟愈合发生率为12.33%。两组年龄、吸烟史、合并糖尿病组间比较，差异有统计学意义（P＜0.05）。愈合组血清miR-203a、miR-31-5p、miR-19b-1-5p水平均高于延迟组（P<0.05）。多因素Logistic回归分析结果显示，年龄≥60岁、合并糖尿病、血清miR-203a、miR-31-5p、miR-19b-1-5p水平降低是股骨颈骨折患者术后骨折延迟愈合的独立危险因素（P＜0.05）。ROC曲线结果显示，三者联合检测的曲线下面积（AUC）（0.95CI）为0.841（0.738~0.936），高于各指标单独应用时的AUC，三者联合检测的灵敏度和特异度亦高于单一指标检测。结论：血清miR-203a、miR-31-5p、miR-19b-1-5p在股骨颈骨折术后骨折延迟愈合患者中呈低表达，是骨折延迟愈合的独立危险因素，三者联合检测对股骨颈骨折患者骨折延迟愈合具有较高的预测价值。

Relationship between Serum miR-203a, miR-31-5p, miR-19b-1-5p Levels and Delayed Healing of Fractures in Patients with Femoral Neck Fractures and its Predictive Value Analysis

ABSTRACT Objective: To explore the relationship between serum microribonucleic acid (miR)-203a, miR-31-5p, miR-19b-1-5p levels and delayed healing of fractures after operation in patients with femoral neck fractures and its predictive value for delayed healing of fractures after operation. Methods: 292 patients with fresh femoral neck fractures who were underwent internal fixation treatment at Affiliated Hospital of Xuzhou Medical University from January 2020 to October 2022 were selected as research subjects. At the followed up examination 4 weeks after operation, the patient''s serum miR-203a, miR-31-5p, and miR-19b-1-5p levels were detected, and patients were divided into delayed group (n=36) and healing group (n=256) according to their fractures healing status. The influencing factors of delayed healing of fractures after operation in patients with femoral neck fractures was analyzed by the multivariate Logistic regression. The predictive value of serum miR-203a, miR-31-5p, and miR-19b-1-5p for delayed healing of fractures after operation in patients with femoral neck fractures was analyzed by the receiver operating characteristic (ROC) curve. Results: At the followed up examination 4 months after operation, and the incidence of delayed healing of fractures was 12.33% . There were significant differences in age, smoking history and combined with diabetes between two groups (P<0.05). The serum miR-203a, miR-31-5p, and miR-19b-1-5p levels in healing group were higher than those in delayed group (P<0.05). Multivariate Logistic regression analysis showed that age greater than or equal to 60 years old, combined with diabetes, reduced levels of serum miR-203a, miR-31-5p, miR-19b-1-5p were independent risk factors for delayed healing of fractures after operation in patients with femoral neck fractures (P<0.05). ROC results showed that the area under the curve (AUC) (0.95CI) of the three indicators joint detected was 0.841 (0.738~0.936), which was higher than the AUC when each indicator was applied separately, and the sensitivity and specificity of the three indicators joint detection were also higher than those of single indicator detected. Conclusion: Serum miR-203a, miR-31-5p, and miR-19b-1-5p are low expressed in patients with delayed healing of fractures after operation of femoral neck fractures, which are independent risk factors for delayed healing of fractures, and the three indicators joint detection has high predictive value for delayed healing of fractures in patients with femoral neck fractures.