老年髋部骨折的预后：白蛋白、淋巴细胞、血红蛋白之效应

Prognosis of hip fractures in elderly patients: Effects of albumin, lymphocyte and hemoglobin

背景:文献报道营养状况不良与老年人髋部骨折术后的死亡存在相关性,但国内此项研究尚未见报道。目的:回顾性分析老年髋部骨折患者入院时血液白蛋白、淋巴细胞数和血红蛋白水平与预后的关系。方法:纳入130例髋部骨折患者,年龄大于70岁,均采用人工全髋关节置换或人工双动头置换治疗。患者入院时测量白蛋白、淋巴细胞数及血红蛋白,置换后随访1年,或者随访至患者死亡,其中有效随访92例。采用Kaplan-Meier法及Log-Rank检验进行生存分析,多因素Cox比例风险模型进行预后多因素分析。结果与结论:92例患者中,20例(22%)白蛋白<35 g/L,67例(73%)淋巴细胞数<1.5×106L-1,56例(61%)血红蛋白<120 g/L。Kaplan-Meier法分析提示,白蛋白正常患者(≥35 g/L)的生存率显著高于白蛋白减低患者(<35 g/L)(P<0.01);淋巴细胞数正常(≥1.5×106L-1)与淋巴细胞数减低(<1.5×106L-1)患者的生存率差异无显著性意义(P>0.05);血红蛋白正常患者(≥120 g/L)的生存率显著高于血红蛋白减低患者(<120 g/L)(P<0.05)。Cox多因素分析显示,白蛋白减低是老年髋部骨折患者死亡的独立预后因素。提示老年髋部骨折患者的预后与其营养状况密切相关,白蛋白及血红蛋白等常规的入院检验可作为判断患者预后的重要指标。

BACKGROUND：Studies have shown that malnutrition was associated with death of elder people after fracture of hip, but there were no above-mentioned reports in China. OBJECTIVE： To retrospectively analyze the relationship of blood albumin, total lymphocyte count and hemoglobin levels to prognosis when elder patients with fracture of hip were on admission. METHODS：130 elderly patients with hip fractures aged ≥ 70 years were included underwent either total hip arthroplasty or bipolar arthroplasty. Admission serum albumin, total lymphocytecount and hemoglobin levels were recorded. The patients were fol owed up for 1 year or til the death. Survival data were available in 92 patients. Rates of survival were calculated by the Kaplan-Meier method and the Log-Rank test. Cox proportional hazard regression model received prognostic multivariate analysis. RESULTS AND CONCLUSION：Of the 92 patients, albumin〈35 g/L in 20 cases （22%）, total lymphocyte count〈1.5×106/L in 67 cases （73%）, and hemoglobin〈120 g/L in 56 cases （61%）. Kaplan-Meier method showed that the survival rate of patients with normal albumin （≥ 35 g/L） was significantly higher than those with reduced albumin （〈35 g/L） （P〈0.01）. No significant difference was detected in the survival rate of patients with normal total lymphocyte count （≥ 1.5×106/L） and reduced total lymphocyte count （〈1.5×106/L） （P〉0.05）. The survival rate of patients with normal hemoglobin （≥ 120 g/L） was significantly higher than those with decreased hemoglobin （〈120 g/L） （P 〈0.05）. Cox multivariate analysis displayed that albumin decrease is an independent prognostic factor for death of patients with hip fracture. Results indicated that the prognosis of elder patients with hip fracture was strongly associated with their nutritional conditions. Albumin and hemoglobin levels at admission can be considered as important indexes for judging patient’s prognosis.