文章摘要
柏茂盛,韦昌辉,彭晨健,张 伟,卢俊浩,王 军.术前预后营养指数和血清转铁蛋白与老年髋部骨折患者术后切口愈合的关系及其预测价值分析[J].,2022,(23):4526-4530
术前预后营养指数和血清转铁蛋白与老年髋部骨折患者术后切口愈合的关系及其预测价值分析
Relationship between Preoperative Prognostic Nutritional Index and Serum Transferrin and Postoperative Wound Healing in Elderly Hip Fracture Patients and Their Predictive Value Analysis
投稿时间:2022-04-23  修订日期:2022-05-17
DOI:10.13241/j.cnki.pmb.2022.23.025
中文关键词: 老年  髋部骨折  切口愈合  预后营养指数  转铁蛋白  影响因素  预测价值
英文关键词: Elderly  Hip fracture  Wound healing  Prognostic nutritional index  Transferrin  Influencing factors  Predictive value
基金项目:国家自然科学基金项目(81772318)
作者单位E-mail
柏茂盛 南京市中医院骨伤科 江苏 南京 210000 bms19930802@163.com 
韦昌辉 南京市中医院骨伤科 江苏 南京 210000  
彭晨健 南京市中医院骨伤科 江苏 南京 210000  
张 伟 南京市中医院骨伤科 江苏 南京 210000  
卢俊浩 南京市中医院骨伤科 江苏 南京 210000  
王 军 南京市中医院骨伤科 江苏 南京 210000  
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中文摘要:
      摘要 目的:研究术前预后营养指数(PNI)和血清转铁蛋白(TRF)与老年髋部骨折(HF)患者术后切口愈合不良(PWH)的关系及其预测价值。方法:选取2020年1月~2022年3月南京市中医院收治的252例接受手术治疗老年HF患者,根据术后切口愈合情况分为PWH组(n=27)和非PWH组(n=225)。收集患者基础资料、术前PNI和血清TRF水平。采用多因素Logistic回归分析老年HF患者术后PWH的影响因素,受试者工作特征(ROC)曲线分析PNI和血清TRF水平对老年HF患者术后PWH的预测价值。结果:252例老年HF患者术后出现27例PWH,其中24例切口长时间不愈合,3例切口裂开。与非PWH组比较,PWH组体质量指数(BMI)和白蛋白、淋巴细胞计数(LC)、PNI、血清TRF水平更低,糖尿病比例和术中出血量更高(P<0.05)。多因素Logistic回归分析显示,BMI≥18.5 kg/m2(OR=0.648,95%CI:0.457~0.919)、PNI(OR=0.954,95%CI:0.932~0.976)、血清TRF(OR=0.484,95%CI:0.307~0.761)升高是老年HF患者术后PWH的保护因素,糖尿病(OR=2.651,95%CI:1.182~5.948)、术中出血量增加(OR=1.013,95%CI:1.005~1.021)是危险因素(P<0.05)。ROC曲线分析显示,PNI和血清TRF水平单独与联合预测老年HF患者术后PWH的曲线下面积(AUC)分别为0.808、0.770、0.871,灵敏度分别为70.37%、55.56%、92.59%,特异度分别为80.65%、85.81%、70.32%。二者联合预测老年HF患者术后PWH的AUC大于二者单独预测(P<0.05)。结论:术前PNI和血清TRF水平降低是老年HF患者术后PWH的危险因素,二者联合对老年HF患者术后PWH的预测价值较高。
英文摘要:
      ABSTRACT Objective: To study the relationship between preoperative prognostic nutritional index (PNI) and serum transferrin (TRF) and postoperative poor wound healing (PWH) in elderly hip fracture (HF) patients and their predictive value. Methods: 252 cases of elderly HF patients who were treated surgically in Nanjing Hospital of Traditional Chinese Medicine from January 2020 to March 2022 were selected, and they were divided into PWH group(n=27) and non PWH group(n=225) according to the postoperative wound healing. Basic data, preoperative PNI and serum TRF levels of patients were collected. Multivariate Logistic regression was used to analyze the influencing factors of postoperative PWH in elderly HF patients. The predictive value of PNI and serum TRF levels on postoperative PWH in elderly HF patients was analyzed by receiver operating characteristic (ROC) curve. Results: There were occurred 27 cases of PWH in 252 elderly HF patients after operation, included 24 cases of incision non-union for a long time, and 3 cases of incision dehiscence. Compared with the non-PWH group, the PWH group had lower body mass index (BMI), albumin, lymphocyte count (LC), PNI and serum TRF, and higher incidence of diabetes mellitus and intraoperative blood loss (P<0.05). Multivariate Logistic regression analysis showed that BMI≥18.5 kg/m2 (OR=0.648, 95%CI: 0.457~0.919), PNI (OR=0.954, 95%CI: 0.932~0.976), serum TRF (OR=0.484, 95%CI: 0.307~0.761) elevated were the protective factors for PWH in elderly HF patients. Diabetes (OR=2.651, 95%CI:1.182~5.948) and increased intraoperative blood loss (OR=1.013, 95%CI: 1.005~1.021) were the risk factor (P<0.05). ROC curve analysis showed that PNI and serum TRF level alone and in combination predicted the area under curve (AUC) of PWH in elderly HF patients after operation were 0.808, 0.770 and 0.871, respectively, and the sensitivity were 70.37%, 55.56% and 92.59%, respectively. The specificity were 80.65%, 85.81% and 70.32%, respectively. The AUC of PWH predicted by the combination of the two methods was greater than that predicted by the two methods alone (P<0.05). Conclusion: Decreased preoperative PNI and serum TRF level are risk factors for postoperative PWH in elderly HF patients, and their combination has a high predictive value for postoperative PWH in elderly HF patients.
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