| Objective: Neurogenic heterotopic ossification is one of commoncomplications in patients with spinal cord injury (SCI). The severe heterotopicossification might limit the degree of joint activities, and even cause ankylosis,reducing the activities of daily living and affecting the recovery of patients.However, there is no effective treatment for neurogenic heterotopicossification until now. Therefore, the analysis on the mechanism and relatedrisk factors of neurogenic heterotopic ossification after SCI is of clinicalsignificance. The α2-HS glycoprotein, also named as human fetuin–A,(Fetuin-A of α2Heremans-Schmid glycoprotein, AHSG) is a plasmaglycoprotein belonging to the fetuin family. Previous studies indicated thatα2-HS glycoprotein could markedly inhibit ectopic calcification. However,there was still lacking of clinical evidence on whether the decrease of α2-HSglycoprotein level was related to the occurrence of neurogenic heterotopicossification. Therefore, we analyzed theα2-HS glycoprotein level and hipheterotopic ossification of SCI patients in this study. The objective was toexplore the relationship between the α2-HS glycoprotein metabolism and theoccurrence of neurogenic heterotopic ossification so as to identify theinfluence of α2-HS glycoprotein metabolism on the neurogenic heterotopicossification after SCI. Meanwhile, the relevant factors and predisposingfactors of neurogenic heterotopic ossification after SCI was discussed in orderto identify the parameters which had predictive value for the heterotopicossification and provide new theory basis for intervention on neurogenicheterotopic ossification.Methods: Seventy-five cases of paraplegic patients after SCI wereenrolled in the rehabilitation department of the third hospital of Hebei medicaluniversity from January in2011to January in2012. They were aged between 16to58years old. The diagnosis of SCI in all patients was confirmed by CTand MRI. According to the results of high-frequency ultrasound on thebilateral hip joint, the enrolled patients were divided into group A and group B.In group A, there were28patients of heterotopic ossification, including1caseof right hip heterotopic ossification,5cases of left hip heterotopic ossificationand22cases of bilateral hip heterotopic ossification. There were25malepatients and3female patients, and the average age was39.9years. The meantime from the diagnosis to the occurrence of heterotopic ossification was2.73months. According to the paraplegia plane and spinal cord injury site, therewere9cases of cervical and upper thoracic injuries,14cases of middle andlower thoracic injuries and5cases of lumbar and below lumber injuries. Theparaplegia plane was consistent with injury level in22cases, and theparaplegia plane was higher than injury level in6cases.In group B, there were47patients of SCI without heterotopic ossification. There were47cases,including42male patients and5female patients, and the average age was33.9years. According to the paraplegia plane and spinal cord injury site, there were17cases of cervical and upper thoracic injuries,20cases of middle and lowerthoracic injuries and10cases of lumbar and below lumber injuries. Theparaplegia plane was consistent with injury level in45cases, and theparaplegia plane was higher than injury level in2cases. Furthermore, the28cases in group A were divided into mature group (20cases) and immaturegroup (8cases) according to the mature degree of neurogenic heterotopicossification in basis of the result of high-frequency ultrasound. Thecomprehensive rehabilitation evaluations were preformed on the enrolledpatients, including sensory and movement level, muscle strength, spasticity,pressure sores, blood clots and so on. We instructed patients and their familymemebers to do physically active and passive activities in order to avoidcontracture, joint mobility limitation due to joint disuse. Meantime, themovements should be gentle so as to avoid joint soft tissue injury, hyperemia,hemorrhage, edema, and even organization which might induce or aggravateectopic ossification. Each enrolled patient was fasted for10hours and3ml venous blood specimens were taken and placed at room temperature for30min. And then, The blood specimens were separated in speed of3200r/minfor6min, and were stored in-70°C refrigerator. A series of parameters weredetected by double antibody sandwich method, includingα2-HS glycoprotein,C-reactive protein, serum calcium, D2D, human bone morphogenetic protein(BMP). The data were processed by statistical software of SPSS13.0.Results:1The level of α2-HS glycoprotein, CRP, serum calcium, D2D, BMP ingroup A and group B was compared between group A and group B bywilcoxon rank-sum test. The result indicated that there was significantdifference of α2-HS glycoprotein, CRP, serum calcium, D2D, BMP betweenthe two groups (Z=-2.169,P=0.03；Z=-5.170,P=0.000；Z=-5.362,P=0.000；Z=-5.204,P=0.000；Z=-5.094,P=0.000). The level of α2-HS glycoprotein ingroup A was obviously lower than group B. In contrast, the level of serumcalcium, D2D, BMP and CRP in group A were higher than group B.2The level of α2-HS glycoprotein, CRP, serum calcium, D2D, BMP inmature group and immature group of group A was compared between group Aand group B by wilcoxon rank-sum test. The result indicated that there was nosignificant difference of α2-HS glycoprotein, CRP, serum calcium, D2D, BMPbetween the two groups (Z=-2.169,P=0.03；Z=-5.170,P=0.000；Z=-5.362,P=0.000；Z=-5.204,P=0.000；Z=-5.094,P=0.000), indicating that there wasno relationship between the level ofα2-HS glycoprotein, CRP, serum calcium,D2D, BMP and mature degree of neurogenic heterotopic ossification.3According to the comparison of composition in two groups bywilcoxon rank-sum test and X2test, there was no difference of age and sexcomposition between the two groups(P>0.05). There was statisticallydifference of bedsore composition between the two groups (χ2=4.414,P=0.036). There was no difference of spasticity composition between the twogroups(χ2=0.447, P=0.507). There was markedly significant difference ofinjury degree between the two groups. According to the ASIA neural functiongrading standard, most of patients in group A were classified into ASIA grade A(100%), and there was markedly significant difference between group A andgroup B(Z=-2.128,P=0.033). Most of SCI patients were belonged to upperthoracic injuries (32.1%), middle and lower thoracic injuries(50%). Therewas no significant difference between group A and group B. It was consideredthat there was no difference of injury site between group A and group B.According to the analysis among serum α2-HS glycoprotein level and otherfactors by multiple linear stepwise regression, there was no correlation amongserum α2-HS glycoprotein level and age, pressure sores, BMP, D2D, serumcalcium. There was positive correlation between serum α2-HS glycoproteinlevel and CRP and spasticity (β=0.253, β=0.225).Conclusion:1The decrease of serum α2-HS glycoprotein level could induce the ofneurogenic heterotopic ossification after spinal cord injury, but there was nocorrelation between mature degree of neurogenic heterotopic ossification andserum α2-HS glycoprotein level.2There was no statistical difference between serum α2-HS glycoproteinand age, pressure ulcers, the serum of BMP, the D2D, calcium, and there waspositive correlation between serum α2-HS glycoprotein and CRP together withspasticity.3Whether the level of plasma α2-HS glycoprotein could be a predictorof heterotopic ossification after spinal cord injury still needed further research.4There was no statistical correlation between the occurrence ofneurogenic heterotopic ossification and SCI patient's age, sex, spasm, injurylevel.5There was statistical correlation between occurrence of neurogenicheterotopic ossification and degree of SCI (ASIA classification), pressureulcer ratio, serum BMP, D2D, serum calcium. |
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