生物可利用25(OH)D、甲状旁腺素对老年髋部骨折术后功能恢复的影响

The effect of bioavailable 25-(OH)D and parathyroid hormone levels on functional recovery in elderly patients with hip fractures

目的研究生物可利用25(OH)D、甲状旁腺素对老年脆性髋部骨折术后功能恢复的影响。方法采用前瞻性队列研究,收集我院2017年5月至2021年11月318例老年髋部骨折患者,选取同时期在体检中心参加体检的健康人为对照组,采用自行设计调查问卷进行调查,检测钙、白蛋白、维生素D结合蛋白、总25(OH)D、甲状旁腺素水平,计算生物可利用25(OH)D水平。随访评价髋部骨折患者术后功能表现,采用多因素Logistic回归模型分析生物可利用25(OH)D、甲状旁腺素与老年脆性髋部骨折功能的相关性。采用受试者工作曲线下面积(receiver operating characteristic,ROC)研究生物可利用25(OH)D、甲状旁腺素与老年脆性髋部骨折术后功能的预测价值。结果本研究共纳入318名患者,总25(OH)D(OR=0.866,95%CI:0.834~0.899,P<0.001)、生物可利用25(OH)D(OR=0.775,95%CI:0.655~0.917,P=0.003)和甲状旁腺素(OR=1.909,95%CI:0.852~0.969,P=0.004)与康复效果有关。ROC曲线分析结果显示,总25(OH)D、生物可利用25(OH)D和甲状旁腺素的曲线下面积分别为0.826、0.644和0.579。结论高总25-(OH)D、高生物可利用25(OH)D、低甲状旁腺素水平促进老年髋部脆性骨折术后功能恢复。

Objective To investigate the effect of bioavailable 25-(OH)Dand parathyroid hormone levels on functional recovery in elderly patients with brittle hip fractures after surgery.Methods A prospective cohort study of 318 adult patients with hip fractures from May 2017 to November 2021 in our hospital was enrolled.Levels of total 25-(OH)D,parathyroid hormone,calcium,albumin,and vitamin D-binding protein were measured.Self-designed questionnaires were collected.The bioavailable 25-(OH)D levels were calculated.A multivariate logistic regression model was used to analyze the association between bioavailable 25-(OH)D and parathyroid hormone levels and functional outcome in the elderly with fragile hip fractures.Receiver Operating Characteristic(ROC)was used to investigate the predictive value of bioavailable 25-(OH)D and parathyroid hormone levels,and postoperative function in the elderly with fragile hip fractures.Results A total of 318 patients were enrolled in this study.Total 25-(OH)D level(OR=0.866,95%CI:0.834-0.899,P<0.001),bioavailable 25-(OH)D level(OR=0.775,95%CI:0.655-0.917,P=0.003),and parathyroid hormone level(OR=1.909,95%CI:0.852-0.969,P=0.004)were associated with rehabilitation outcomes.ROC curve analysis showed that the areas under the curve of total 25-(OH)D,bioavailable 25-(OH)D,and parathyroid hormone were 0.826,0.644 and 0.579,respectively.Conclusion High total 25-(OH)D level,high bioavailable 25-(OH)D level,and low parathyroid hormone level promote functional recovery after hip fracture surgery in the elderly.