PNI/CRP比值预测髋部骨折患者术后转归的临床意义

Clinical Value of PNI/CRP in Predicting the Prognosis Outcome of Patients with Hip Fracture after Operation

目的:探讨预后营养指数(PNI)/C反应蛋白(CRP)比值(PNI/CRP)预测髋部骨折患者手术预后的价值。方法:选取我院收治的髋部骨折患者83例,测量并记录所有患者一般资料、majeed评分,检测患者血清Ⅰ型前胶原氨基端前肽(PINP)、骨钙素(BGP)、骨碱性磷酸酶(BALP)、PNI、CRP、PNI/CRP等指标。进行为期12个月的随访,随访期间死亡的患者定义为预后不良组,其余患者定义为预后良好组。随访结束后,整理并分析可能影响患者预后的潜在因素并分析其预测价值。结果:随访结束时,46人预后良好(预后良好组),31人死亡(预后不良组)。Cox单多因素回归分析发现,PNI(P=0.013,RR=0.768)和PNI/CRP(P=0.003,RR=0.216)是髋部骨折患者手术不良预后的独立影响因素。ROC曲线分析发现,PNI/CRP的曲线下面积(AUC)最佳,为0.887,最佳诊断点为10.84,其敏感度为64.52%,特异度为97.83%。结论:PNI/CRP对髋部骨折患者术后的预后有较好的预测能力,有望作为临床评估髋部骨折患者术后预后风险的指标之一。

Objective： To explore the predictive value of prognostic nutrition index（PNI）/C-reactive protein（CRP） ratio（PNI/CRP） in the prognosis of hip fracture patients. Methods： 83 cases of hip fractures treated in our hospital were involved. The general data,majeed scores,the serum type I procollagen amino propeptide（PINP）,osteocalcin（BGP）,bone alkaline phosphatase（BALP）,PNI,CRP,PNI/CRP and other indicators of all patients were measured and recorded. A follow-up period of 12 months was applied. Patients who died during follow-up were defined as having a poor prognosis,and the remaining patients were defined as having a good prognosis. After the end of follow-up,the potential factors that may affect the patient＇s prognosis were collated and analyzed and their predictive value was analyzed. Results： At the end of followup,46 patients had a good prognosis（good prognosis group） and 31 patients died（poor prognosis group）.Cox single multivariate regression analysis found that PNI（P = 0.013,RR = 0.768） and PNI/CRP（P= 0.003,RR = 0.216） were independent predictors of poor surgical outcome in patients with hip fractures.ROC curve analysis found that the area under the curve（AUC） of PNI/CRP was the best,0.887,the best diagnostic point was 10. 84,the sensitivity was 64. 52%,and the specificity was 97. 83%. Conclusion： PNI/CRP has a good ability to predict the prognosis of patients with hip fracture after operation,and it is expected to be one of the indexes for clinical evaluation of prognosis risk of hip fracture patients.