Correlation between peripheral blood PKM2 and TNFR2 levels and delayed fracture healing in patients with subtrochanteric femoral fractures

@article{xiangli2026correlation,
  title = {{Correlation between peripheral blood PKM2 and TNFR2 levels and delayed fracture healing in patients with subtrochanteric femoral fractures}},
  author = {SHI Xiangli and YANG Xiaolin and LU Ping and SHEN Yang and WANG Liangliang},
  journal = {徐州医科大学学报},
  year = {2026},
  month = sep,
  doi = {10.12467/j.issn.2096-3882.20260302},
  url = {https://doi.org/10.12467/j.issn.2096-3882.20260302},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - Correlation between peripheral blood PKM2 and TNFR2 levels and delayed fracture healing in patients with subtrochanteric femoral fractures
AU  - SHI Xiangli
AU  - YANG Xiaolin
AU  - LU Ping
AU  - SHEN Yang
AU  - WANG Liangliang
PY  - 2026
DA  - 2026/09/01
JO  - 徐州医科大学学报
DO  - 10.12467/j.issn.2096-3882.20260302
UR  - https://doi.org/10.12467/j.issn.2096-3882.20260302
AB  - Objective To investigate the correlation between peripheral blood pyruvate kinase M2 (PKM2) and tumor necrosis factor receptor 2 (TNFR2) levels and delayed fracture healing (DFH) in patients with subtrochanteric femoral fractures (STFs), and to evaluate their predictive value.Methods A prospective study was conducted, involving 157 patients with STFs admitted to Department of Orthopedics, Rugao Hospital Affiliated to Nantong University from January 2022 to March 2025, along with 112 healthy volunteers undergoing routine physical examinations during the same period as the control group. Peripheral blood levels of PKM2, TNFR2, and bone metabolism markers, including β-C-terminal telopeptide of type Ⅰ collagen (β-CTX) and procollagen type Ⅰ N-terminal propeptide (PINP), were measured by enzyme-linked immunosorbent assay (ELISA). Pearson correlation analysis was performed to assess the relationships between peripheral blood PKM2 and TNFR2 levels and bone metabolism indicators in patients with STFs. According to fracture healing status at 3 months after surgery, the patients were divided into the DFH group and the non-DFH group. Risk factors for DFH and the predictive performance of peripheral blood PKM2 and TNFR2 levels were analyzed. Internal validation was performed using 1 000 bootstrap resampling iterations.Results Compared with the control group, patients in the STF group exhibited significantly increased peripheral blood PKM2 and β-CTX levels, while PINP and TNFR2 levels were significantly decreased (P<0.05). In patients with STFs, peripheral blood PKM2 levels were positively correlated with β-CTX levels and negatively correlated with PINP levels (r=0.674 and -0.669, respectively; both P<0.001). TNFR2 levels were negatively correlated with β-CTX levels and positively correlated with PINP levels (r=-0.657 and 0.663, respectively; both P<0.001). Among the 157 patients with STFs, the incidence of DFH was 39.49% (62/157). Multivariate analysis showed that diabetes mellitus, β-CTX ≥15.46 ng/L, and PKM2 ≥258.14 U/mL were independent risk factors for DFH in patients with STFs, whereas PINP ≥16.65 ng/L and TNFR2 ≥158.03 ng/L were independent protective factors (P<0.05). Receiver operating characteristic (ROC) curve analysis demonstrated that the area under the curve (AUC) values of PKM2, TNFR2, and their combination for predicting DFH in patients with STFs were 0.803, 0.785, and 0.895, respectively. The combined model showed significantly superior predictive performance compared with either marker alone (P<0.05). Internal validation yielded a C-index of 0.895, indicating good predictive stability.Conclusions Elevated peripheral blood PKM2 levels and decreased TNFR2 levels in patients with STFs are associated with bone metabolism imbalance and delayed fracture healing. Combined detection of PKM2 and TNFR2 demonstrates high predictive efficacy for DFH in patients with STFs and may provide a reference for early clinical intervention.
SN  - 2096-3882
ER  -