CAJ | 학술논문

背景：文献报道营养状况不良与老年人髋部骨折术后的死亡存在相关性，但国内此项研究尚未见报道。 　　目的：回顾性分析老年髋部骨折患者入院时血液白蛋白、淋巴细胞数和血红蛋白水平与预后的关系。 　　方法：纳入130例髋部骨折患者，年龄大于70岁，均采用人工全髋关节置换或人工双动头置换治疗。患者入院时测量白蛋白、淋巴细胞数及血红蛋白，置换后随访1年，或者随访至患者死亡，其中有效随访92例。采用 Kaplan-Meier法及Log-Rank检验进行生存分析，多因素Cox比例风险模型进行预后多因素分析。 　　结果与结论：92例患者中，20例(22%)白蛋白<35 g/L，67例(73%)淋巴细胞数<1.5×106 L-1，56例(61%)血红蛋白<120 g/L。Kaplan-Meier法分析提示，白蛋白正常患者(≥35 g/L)的生存率显著高于白蛋白减低患者(<35 g/L)(P<0.01)；淋巴细胞数正常(≥1.5×106 L-1)与淋巴细胞数减低(<1.5×106 L-1)患者的生存率差异无显著性意义(P>0.05)；血红蛋白正常患者(≥120 g/L)的生存率显著高于血红蛋白减低患者(<120 g/L)(P<0.05)。Cox多因素分析显示，白蛋白减低是老年髋部骨折患者死亡的独立预后因素。提示老年髋部骨折患者的预后与其营养状况密切相关，白蛋白及血红蛋白等常规的入院检验可作为判断患者预后的重要指标。
배경：문헌보도영양상황불량여노년인관부골절술후적사망존재상관성，단국내차항연구상미견보도。 　　목적：회고성분석노년관부골절환자입원시혈액백단백、림파세포수화혈홍단백수평여예후적관계。 　　방법：납입130례관부골절환자，년령대우70세，균채용인공전관관절치환혹인공쌍동두치환치료。환자입원시측량백단백、림파세포수급혈홍단백，치환후수방1년，혹자수방지환자사망，기중유효수방92례。채용 Kaplan-Meier법급Log-Rank검험진행생존분석，다인소Cox비례풍험모형진행예후다인소분석。 　　결과여결론：92례환자중，20례(22%)백단백<35 g/L，67례(73%)림파세포수<1.5×106 L-1，56례(61%)혈홍단백<120 g/L。Kaplan-Meier법분석제시，백단백정상환자(≥35 g/L)적생존솔현저고우백단백감저환자(<35 g/L)(P<0.01)；림파세포수정상(≥1.5×106 L-1)여림파세포수감저(<1.5×106 L-1)환자적생존솔차이무현저성의의(P>0.05)；혈홍단백정상환자(≥120 g/L)적생존솔현저고우혈홍단백감저환자(<120 g/L)(P<0.05)。Cox다인소분석현시，백단백감저시노년관부골절환자사망적독립예후인소。제시노년관부골절환자적예후여기영양상황밀절상관，백단백급혈홍단백등상규적입원검험가작위판단환자예후적중요지표。
BACKGROUND:Studies have shown that malnutrition was associated with death of elder people after fracture of hip, but there were no above-mentioned reports in China. OBJECTIVE: To retrospectively analyze the relationship of blood albumin, total lymphocyte count and hemoglobin levels to prognosis when elder patients with fracture of hip were on admission. METHODS:130 elderly patients with hip fractures aged ≥ 70 years were included underwent either total hip arthroplasty or bipolar arthroplasty. Admission serum albumin, total lymphocytecount and hemoglobin levels were recorded. The patients were fol owed up for 1 year or til the death. Survival data were available in 92 patients. Rates of survival were calculated by the Kaplan-Meier method and the Log-Rank test. Cox proportional hazard regression model received prognostic multivariate analysis. RESULTS AND CONCLUSION:Of the 92 patients, albumin<35 g/L in 20 cases (22%), total lymphocyte count<1.5×106/L in 67 cases (73%), and hemoglobin<120 g/L in 56 cases (61%). Kaplan-Meier method showed that the survival rate of patients with normal albumin (≥ 35 g/L) was significantly higher than those with reduced albumin (<35 g/L) (P<0.01). No significant difference was detected in the survival rate of patients with normal total lymphocyte count (≥ 1.5×106/L) and reduced total lymphocyte count (<1.5×106/L) (P>0.05). The survival rate of patients with normal hemoglobin (≥ 120 g/L) was significantly higher than those with decreased hemoglobin (<120 g/L) (P <0.05). Cox multivariate analysis displayed that albumin decrease is an independent prognostic factor for death of patients with hip fracture. Results indicated that the prognosis of elder patients with hip fracture was strongly associated with their nutritional conditions. Albumin and hemoglobin levels at admission can be considered as important indexes for judging patient’s prognosis.