血清指标对陈旧性胸腰段骨折患者预后影响及营养干预的实验研究

Experimental study on the prognostic effect of serum indicators on patients with old thoracic and lumbar fractures and nutritional intervention

目的分析血清学、营养指标与陈旧性胸腰段骨折患者预后的相关性,并评价营养干预对患者预后的实验研究。方法选择2019年1月至2023年1月在河北省沧州中西医结合医院行人工椎体置换术治疗的60例陈旧性胸腰段骨折患者作为研究对象,依据患者预后分为预后不良组及预后良好组,测定两组患者前白蛋白(PA)、血红蛋白(HB)、转铁蛋白(TF)、白蛋白(ALB)、总蛋白(TP)、肌酐(Cr)、淋巴细胞(LYM)及血钙水平,并计算患者预后营养指数(PNI),采用非条件Logistic多因素模型分析血清指标及PNI对患者预后的影响,采用ROC曲线评价血清指标及PNI对患者预后的预测效能。结果预后不良组患者PA、HB、TF、ALB、TP、LYM、血钙水平及PNI均低于预后良好组患者,Logistic回归分析显示,HB、ALB、TF、LYM、血钙及PNI为患者预后不良独立危险因素(OR=0.476~3.272,P=0.000~0.042,95%CI=0.269~4.117),ROC曲线分析结果显示,ALB、TF、LYM、血钙及PNI对预后不良发生AUC面积分别为0.668、0.750、0.718、0.641、0.865,PNI对预后不良预测灵敏度为86.89%,特异度为82.77%。结论血清学指标及患者营养状态与陈旧性胸腰段骨折患者预后关系密切,可作为患者预后的重要预测指标。

Objective Analyze the correlation between serum and nutritional indicators and the prognosis of patients with old thoracolumbar fractures,and evaluate the experimental study of nutritional intervention on patient prognosis.Methods 60 patients with old thoracolumbar fractures treated by artificial vertebral replacement in our hospital from January 2019 to January 2023 were divided into poor prognosis group and good prognosis group according to their prognosis.The levels of prealbumin(PA),hemoglobin(HB),transferrin(TF),albumin(ALB),total protein(TP),creatinine(Cr),lymphocyte(LYM)and blood calcium in the two groups were measured,and the prognostic nutritional index(PNI)was calculated.Results the levels of PA,HB,TF,ALB,TP,LYM,blood calcium and PNI in the poor prognosis group were lower than those in the good prognosis group.Logistic regression analysis showed that HB,ALB,TF,LYM,blood calcium and PNI were independent risk factors for poor prognosis(OR=0.476~3.272,P=0.000~0.042,95%CI=0.269~4.117).ROC curve analysis showed that ALB,TF,LYM,blood calcium and PNI were 0.668,0.750,0.718,0.641,0.865,The sensitivity and specificity of PNI in predicting poor prognosis were 86.89%and 82.77%.Conclusion Serological indicators and patient nutritional status are closely related to the prognosis of patients with old thoracolumbar fractures,and can be used as important prognostic indicators for patients.