Predictive value of combined serum DKK1, SETDB1 and SMURF1 tests for postoperative delayed healing in patients with tibial shaft fractures

doi:10.11958/20253266

Abstract

Abstract:

Objective To investigate the predictive value of serum levels of Dickkopf-related protein 1 (DKK1), SET domain bifurcated 1 (SETDB1) and SMAD specific E3 ubiquitin protein ligase 1 (SMURF1) on delayed healing in tibial shaft fracture patients. Methods A total of 210 patients who underwent surgical treatment for tibial shaft fractures were enrolled as study subjects, and patients were categorized into the normal healing group (n = 142) and the delayed healing group (n = 68) based on the presence or absence of postoperative delayed fracture union. Serum levels of DKK1, SETDB1 and SMURF1 were measured at 1 day, 1 week, 4 weeks and 8 weeks postoperatively using enzyme-linked immunosorbent assay (ELISA). Clinical data were collected from both groups, and multivariate Logistic regression analysis was performed to identify factors influencing postoperative delayed healing. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive value of serum DKK1, SETDB1 and SMURF1 levels individually and in combination for delayed healing following surgery in patients with tibial shaft fractures. Results The proportions of cardiovascular disease, hypertension and osteoporosis were higher in the delayed group than those in the normal group (P<0.05). At all measured time points, serum levels of DKK1 and SETDB1 were significantly lower in the delayed healing group than those in the normal healing group, whereas SMURF1 level was significantly higher (P<0.05). Multivariate Logistic regression analysis revealed that decreased serum levels of DKK1 and SETDB1, along with elevated SMURF1 levels, were independent risk factors for postoperative delayed healing (P<0.05). ROC curve analysis demonstrated that the combined detection of DKK1, SETDB1 and SMURF1 had high predictive accuracy for delayed healing, with an area under the curve (AUC) of 0.931 (95%CI:0.897-0.966，P<0.05). Conclusion The combined detection of serum DKK1, SETDB1 and SMURF1 can effectively predict the risk of postoperative delayed healing in patients with tibial shaft fracture, thereby facilitating early clinical identification of high-risk individuals and guiding the development of targeted intervention strategies.

Key words: tibial fractures, fracture healing, DKK1, SETDB1, SMURF1, delayed healing

CLC Number:

R687.3

Figures/Tables 7

References 24

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组别		n	性别（男/女）		年龄（<50岁/≥50岁）				吸烟史		饮酒史
正常组		142	98/44		59/83				25（17.61）		8（5.63）
延迟组		68	46/22		21/47				9（13.24）		5（7.35）
χ²			0.040		2.219				0.647		0.234
组别			心血管疾病		糖尿病			高血压		骨质疏松
正常组			31（21.83）		30（21.13）			24（16.90）		28（19.72）
延迟组			36（52.94）		22（32.35）			35（51.47）		33（48.53）
χ²			20.484^＊＊		3.110			27.200^＊＊		18.519^＊＊
组别	骨折原因							骨折类型
组别	交通事故致伤			高处坠落伤		重物砸伤	运动损伤	开放性骨折		闭合性骨折
正常组	62（43.66）			33（23.24）		26（18.31）	21（14.79）	69（48.59）		73（51.41）
延迟组	39（57.35）			16（23.53）		8（11.76）	5（7.35）	37（54.41）		31（45.59）
χ²	5.064							0.623

组别		n	性别（男/女）		年龄（<50岁/≥50岁）				吸烟史		饮酒史
正常组		142	98/44		59/83				25（17.61）		8（5.63）
延迟组		68	46/22		21/47				9（13.24）		5（7.35）
χ²			0.040		2.219				0.647		0.234
组别			心血管疾病		糖尿病			高血压		骨质疏松
正常组			31（21.83）		30（21.13）			24（16.90）		28（19.72）
延迟组			36（52.94）		22（32.35）			35（51.47）		33（48.53）
χ²			20.484^＊＊		3.110			27.200^＊＊		18.519^＊＊
组别	骨折原因							骨折类型
组别	交通事故致伤			高处坠落伤		重物砸伤	运动损伤	开放性骨折		闭合性骨折
正常组	62（43.66）			33（23.24）		26（18.31）	21（14.79）	69（48.59）		73（51.41）
延迟组	39（57.35）			16（23.53）		8（11.76）	5（7.35）	37（54.41）		31（45.59）
χ²	5.064							0.623

组别	n	术后1 d	术后1周	术后4周	术后8周
正常组	142	3.74±0.59	2.93±1.13^a	2.68±0.94^ab	2.25±0.68^abc
延迟组	68	2.93±0.61	2.62±0.67^a	2.27±0.89^ab	2.01±0.54^abc
t		9.213^＊＊	2.089^＊	3.006^＊＊	2.549^＊
F_时间/F_组内/F_交互		69.191^＊＊/65.851^＊＊/4.312^＊＊

组别	n	术后1 d	术后1周	术后4周	术后8周
正常组	142	3.74±0.59	2.93±1.13^a	2.68±0.94^ab	2.25±0.68^abc
延迟组	68	2.93±0.61	2.62±0.67^a	2.27±0.89^ab	2.01±0.54^abc
t		9.213^＊＊	2.089^＊	3.006^＊＊	2.549^＊
F_时间/F_组内/F_交互		69.191^＊＊/65.851^＊＊/4.312^＊＊

组别	n	术后1 d	术后1周	术后4周	术后8周
正常组	142	57.24±2.71	52.69±1.36^a	50.37±1.09^ab	51.89±1.34^abc
延迟组	68	50.26±3.12	45.34±1.04^a	49.33±2.01^ab	50.76±1.25^abc
t		16.616^＊＊	39.216^＊＊	4.860^＊＊	5.842^＊＊
F_时间/F_组内/F_交互		232.793^＊＊/924.091^＊＊/166.617^＊＊