术前预后营养指数、血小板淋巴细胞比值与老年髋部骨折患者预后的关系

The relationship between preoperative prognostic nutritional index,platelet-lymphocyte ratio and prognosis of elderly patients with hip fracture

目的探讨术前预后营养指数(PNI)、血小板淋巴细胞比值(PLR)与老年髋部骨折患者预后的关系。方法回顾性分析2016年1月至2019年6月在该科室接受手术治疗的140例老年髋部骨折患者的临床资料。根据患者术后1年生存情况分为存活组(102例)和死亡组(38例)。收集两组患者年龄、性别及术前血小板计数、清蛋白水平、淋巴细胞计数等临床资料。采用多因素Logistic回归分析老年髋部骨折患者术后1年死亡的危险因素。采用受试者工作特征曲线(ROC曲线)和Kaplan-Meier法分析PNI、PLR对老年髋部骨折患者不良预后的评估价值。结果死亡组患者年龄、美国麻醉医师协会分级(ASA分级)、清蛋白水平、血小板计数、淋巴细胞计数、PNI、PLR与存活组比较,差异均有统计学意义(P<0.05)。低PNI组患者生存率低于高PNI组,高PLR组患者生存率低于低PLR组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、ASA分级、清蛋白水平、PNI、PLR是老年髋部骨折患者术后1年死亡的影响因素(P<0.05)。ROC曲线分析结果显示,PNI和PLR联合检测预测老年髋部骨折患者不良预后的ROC曲线下面积为0.922,灵敏度和特异度分别为0.900和0.838,均高于PNI、PLR单独检测。结论术前PNI、PLR与老年髋部骨折患者的生存预后密切相关,联合检测PNI、PLR可作为预测老年髋部骨折患者不良临床结局的参考指标。

Objective To investigate the relationship between preoperative prognostic nutritional index(PNI),platelet-lymphocyte ratio(PLR)and prognosis of elderly patients with hip fracture.Methods The clinical data of 140 elderly patients with hip fractures who underwent surgical treatment in this department from January 2016 to June 2019 were analyzed retrospectively.The patients were divided into survival group(102 cases)and death group(38 cases)according to their 1-year survival status after operation.The age,gender and preoperative platelet count,albumin level,lymphocyte count and other clinical data of the two groups of patients were collected.Multivariate Logistic regression was used to analyze the risk factors of death in elderly patients with hip fracture at 1 year after surgery.The receiver operating characteristic curve(ROC curve)and Kaplan-Meier method were used to analyze the evaluation value of PNI and PLR for the poor prognosis of elderly patients with hip fracture.Results There were significant differences in age,American association of anesthesiologists grade(ASA grade),albumin level,platelet count,lymphocyte count,PNI and PLR between death group and survival group(P<0.05).The survival rate of low PNI group was lower than that of high PNI group,and the survival rate of high PLR group was lower than that of low PLR group,the differences were statistically significant(P<0.05).The results of multivariate Logistic regression analysis showed that age,ASA grade,albumin level,PNI,and PLR were influence risk factors that affected the death of elderly patients with hip fracture 1 year after surgery(P<0.05).The results of ROC curve analysis showed that the area under the ROC curve for the combined detection of PNI and PLR to predict the poor prognosis of elderly hip fracture patients was 0.922,and the sensitivity and specificity were 0.900 and 0.838,respectively,which were higher than those of PNI and PLR alone.Conclusion The preoperative PNI and PLR are closely related to the survival and prognosis of elderly patients with hip fracture.Combined detection of PNI and PLR could be used as a reference index for predicting adverse clinical outcomes of elderly patients with hip fracture.