Prognostic Value of Serum β-CTX and TPINP Levels for Fracture Healing in Patients with Tibial Fractures After Surgery

LIU Shasha; DOU Zhi; SUN Yaohui; LAI Xiaojuan; ZHANG Lixia

doi:10.13730/j.issn.2097-2148.2023.11.009

Abstract：Objective To explore the predictive value of serum type Ⅰ collagen carboxyl-terminal peptide β-special sequence(β-CTX)and total type Ⅰ collagen amino terminal prolongation peptide(TPINP)levels on postoperative tibial fracture healing.Methods A total of 122 patients with tibial fracture admitted to author's hospital from February 2020 to February 2023 were selected as the subjects.The patients were divided into normal healing group(n=105)and delayed healing group(n=17)according to the postoperative fracture healing.The levels of serum β-CTX and TPINP were detec-ted by electrochemiluminescence;the predictive value of serum β-CTX and TPINP for postoperative fracture healing in pa-tients with tibial fracture was evaluated by receiver operating characteristic(ROC)curve;the influencing factors of post-operative fracture healing in patients with tibial fracture were investigated by binary Logistic stepwise regression analysis.Results The proportion of age ≥60 years old,diabetes history,open fracture,postoperative combined osteofascial com-partment and postoperative local infection in delayed healing group were higher than those in normal healing group(all P＜0.05).The serum β-CTX level in delayed healing group was higher than that in normal healing group,and the TPINP level was lower than that in normal healing group(all P＜0.05).The area under the curve(AUC)and 95％confidence interval(CI)of serum β-CTX and TPINP were 0.759(0.708-0.810)and 0.842(0.791-0.893)for predicting postoper-ative fracture healing in patients with tibial fracture,the cut-off value were 0.61 ng/ml and 52.46 ng/ml respectively,the specificity and sensitivity were 56.82％,65.14％and 92.23％,92.23％respectively,the AUC predicted by the two was 0.901(0.850-0.952),the specificity was 86.71％,and the sensitivity was 85.04％.Binary Logis-tic stepwise regression analysis showed that open fracture(OR=1.910,95％CI:1.363-2.675)and postoperative com-bined osteofascial compartment syndrome(OR=2.237,95％CI:1.538-3.252),β-CTX≥0.61 ng/ml(OR=3.025,95％CI:1.943-4.711),TPINP≤52.46 ng/ml(OR=2.519,95％CI:1.692-3.750)were independent risk factors for delayed healing of tibial fractures after surgery.Conclusion High expression of β-CTX and low expression of TPINP are associated with delayed fracture healing in patients with tibial fracture after surgery.These two indexes can be used as bi-ological markers to predict fracture healing in patients with tibial fracture after surgery,which have clinical application value.