重症患者骨质流失的危险因素分析

Risk factors of bone loss in patients with critical illness

目的 比较重症患者入出ICU时的骨质变化,探索引起重症患者骨质流失的独立危险因素。方法 收集2019年7月至2021年7月浙江大学医学院附属金华医院ICU的重症患者101例,采用超声骨密度仪测量患者入出ICU时的骨密度,根据是否发生骨质流失将患者分为流失组和对照组,比较两组患者临床资料的差异,通过单因素和多因素logistic回归分析引起患者骨质流失的独立危险因素。结果 发生骨质流失的患者48例,未发生骨质流失的患者53例。流失组入ICU时T值为-1.7(-2.7,-1.2),出ICU时为-2.2(-3.4,-1.6),对照组入ICU时T值为-1.6(-2.4,-0.8),出ICU时为-1.9(-2.7,-0.8);流失组入ICU时超声传播速度(SOS)为(3 897±212)m/s,出ICU时为(3 830±311)m/s,对照组入ICU时SOS为(3 908±259)m/s,出ICU时为(3 880±282)m/s。单因素logistic回归分析表明引起患者骨质流失的危险因素有高龄、入ICU氧合指数低、住ICU期间进行连续肾脏替代治疗(CRRT)、入ICU时序贯器官衰竭(SOFA)评分高、机械通气时间长、住ICU时间长以及入ICU时血白细胞计数增高,多因素logistic回归发现引起患者骨质流失的独立危险因素有高龄、入ICU时氧合指数低、住ICU期间行CRRT治疗、入ICU时SOFA评分高以及入ICU时血白细胞计数增高。结论 引起重症患者骨质流失的独立危险因素有高龄、入ICU氧合指数低、住ICU期间进行CRRT治疗、入ICU时SOFA评分高以及入ICU时血白细胞计数增高。

Objective To investigate the risk factors of bone loss in patients with critical illness. Methods One hundred and one patients with critical illness admitted in intensive care unit(ICU) of Affiliated Jinhua Hospital Zhejiang University School of Medicine from July 2019 to July 2021 were enrolled. Quantitative ultrasonography was used to assess the bone mass, the bone mass at admission and discharge was compared;there were 48 patients with bone loss(bone loss group) and 53 patients without bone loss(control group) during ICU stay. Clinical data of the two groups were compared, the risk factors associated with bone loss were analyzed with univariate and multivariate logistic analysis.Results The T score on admission was-1.7(-2.7,-1.2)in bone loss group and-1.6(-2.4,-0.8)in control group, while-2.2(-3.4,-1.6)and-1.9(-2.7,-0.8)on discharge. The average speed of ultrasound on admission was(3 897±212) m/s in bone loss group and(3 908 ± 259) m/s in control group, while(3 830 ± 311) m/s and(3 880 ± 282) m/s on discharge.Univariate logistic regression analysis showed that older age, low PaO2/FiO2at ICU admission, CRRT therapy during ICU,high SOFA score at admission, long mechanical ventilation time, long ICU stay and high WBC at admission were associated with bone loss. Multivariate logistic regression analysis showed that the older age, low PaO2/FiO2at ICU admission, CRRT therapy during ICU, high SOFA score and high WBC at admission were independent risk factors for bone loss.Conclusion Critically ill patients admitted in ICU with older age, low PaO2/FiO2, CRRT therapy, high SOFA score and high WBC may have high risk for bone loss.