【摘要】 目的 探讨脊柱骨折伴创伤性脊髓损伤病人血清胶质纤维酸性蛋白(glial fibrillary acidic protein, GFAP)、胰岛素样生长因子-1(Insulin-like growth factor-1,IGF-1)水平与神经功能及预后关系。方法 前瞻性选取2021年10月～2023年10月92例脊柱骨折伴创伤性脊髓损伤病人为观察组，根据神经功能分为轻、中、重度组，预后情况分为预后良好和不良组，另选择仅脊柱骨折病人92例为对照组。酶联免疫吸附法测定GFAP和IGF-1水平；逐步向前的多因素Logistic回归分析预后影响因素；受试者工作特征(ROC)曲线分析GFAP、IGF-1对病人预后预测效能。结果 对照组GFAP为(16.86±3.25)μg/L,IGF-1为(146.24±31.47)μg/L),观察组分别为(32.57±7.21)μg/L和(97.81±22.43)μg/L),两组比较差异有统计学意义(P<0.05),与神经功能损伤程度(轻度组GFAP=22.15±4.75μg/L,IGF-1=116.27±22.31μg/L;中度组GFAP=36.24±9.64μg/L,IGF-1=92.14±17.68μg/L;重度组GFAP=55.68±13.54μg/L,IGF-1=51.78±14.64μg/L)相关(P<0.05)。预后良好组GFAP为(26.48±5.86)μg/L,IGF-1为(112.23±24.15)μg/L,预后不良组分别为(42.05±8.79)μg/L、(75.39±15.62)μg/L,两组比较差异有统计学意义(P<0.05)。多因素Logistic回归分析结果表明，Frankel分级、GFAP、IGF-1水平是病人预后不良影响因素(Frankel分级OR=2.460,GFAP OR=1.926,IGF-1 OR=0.548,P<0.05)。ROC曲线分析显示，血清GFAP、IGF-1联合预测病人预后不良曲线下面积为0.983,显著大于单独预测(Z=2.087、2.398,P=0.037、0.016)。结论 脊柱骨折伴创伤性脊髓损伤病人血清GFAP上升，IGF-1下降，与神经功能损伤相关，其中GFAP是病人预后危险因素，IGF-1是保护因素。更多还原

【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.更多还原