基于营养相关指标的髋部骨折患者不良预后风险模型效能分析

黄一笑; 周雪来; 王永乐; 张魁贤

doi:10.16766/j.cnki.issn.1674-4152.003631

基于营养相关指标的髋部骨折患者不良预后风险模型效能分析

doi: 10.16766/j.cnki.issn.1674-4152.003631

浙江中医药大学附属温州市中医院骨伤科，浙江温州 325000

基金项目:

浙江省中医药科技计划项目 2024ZL990

详细信息

通讯作者:
张魁贤，E-mail: 502696575@qq.com

中图分类号: R683.42;R446.11
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出版历程
- 收稿日期: 2024-01-08
- 网络出版日期: 2024-11-19

Effectiveness analysis of risk model for poor prognosis of hip fracture patients based on nutrition related indicators

Department of Orthopedics and Traumatology, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的监测髋部骨折患者手术前后的营养水平，并基于营养相关指标构建不良预后风险模型，探讨其模型的预测效能。方法选取2020年2月—2022年2月于浙江中医药大学附属温州市中医院骨科接受治疗的172例髋骨骨折患者作为研究对象，根据随访结果将其分为生存组和死亡组，对比2组患者的营养相关指标，并采用logistic回归分析构建髋部骨折患者不良预后的风险模型，通过ROC曲线分析评估该模型的预测效能。结果截至末次随访时间，共失访3例患者，51例患者死亡纳入死亡组，118例纳入生存组。多因素logistic回归分析显示，年龄增加、血红蛋白、白蛋白、前白蛋白以及血肌酐水平降低均是髋部骨折患者出现不良预后的独立危险因素(P < 0.05)；ROC曲线显示，联合预测(AUC=0.989，灵敏度为94.1%，特异度为96.6%，准确率为95.86%)的预测效能高于单项指标的预测效能。结论基于四者营养相关指标构建的不良预后风险模型对预测髋部骨折患者死亡的发生具有良好的诊断效能。
- 髋骨骨折 /
- 预测模型 /
- 白蛋白 /
- 前白蛋白 /
- 血红蛋白
Abstract: Objective Based on the nutrition-related indexes of patients with hip fracture, a risk model of poor prognosis was established and its predictive efficiency was analyzed. Methods From February 2020 to February 2022, a total of 172 patients with hip fracture who were treated in the Department of Orthopaedics, Wenzhou TCM Hospital of Zhejiang Chinese Medical University were selected as the research objects. According to the follow-up results, they were divided into survival group and death group. The nutritional related indexes of the two groups were compared. Logistic regression analysis was used to build a risk model for predicting poor prognosis of patients with hip fracture, and ROC curve analysis was conducted to evaluate the predictive efficiency of the model. Results Up to the last follow-up time, 3 patients were lost, 51 patients died and were included in death group, 118 patients were included in the survival group. Multivariate logistic regression showed that increasing age and reducing hemoglobin, albumin, prealbumin levels and decreasing serum creatinine were independent risk factors for poor prognosis in patients with hip fracture (P < 0.05). The ROC curve demonstrated that the joint prediction had higher predictive efficiency (AUC=0.989, sensitivity was 94.1%, specificity was 96.6%, accuracy was 95.86%) compared to single index. Conclusion The risk model based on the four nutritional indicators has good diagnostic efficiency in predicting the mortality of patients with hip fracture.
- Hip fracture /
- Prediction model /
- Albumin /
- Prealbumin /
- Hemoglobin

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图 1 髋部骨折不良预后风险模型的ROC曲线

Figure 1. ROC curve of poor prognostic risk model for hip fracture

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表 1 死亡组和生存组髋部骨折患者的一般资料比较

Table 1. Comparison of general data between death and survival groups of patients with hip fracture

项目	生存组(n=118)	死亡组(n=51)	统计量	P值
年龄(x±s，岁)	69.04±8.48	76.36±7.94	5.388^a	< 0.001
性别[例(%)]			1.027^b	0.311
男性	39(33.05)	21(41.18)
女性	79(66.95)	30(58.82)
BMI(x±s)	21.16±2.03	19.86±1.54	4.556^a	< 0.001
吸烟史[例(%)]	23(19.49)	6(11.76)	1.496^b	0.211
饮酒史[例(%)]	7(5.93)	2(3.92)	0.286^b	0.593
基础疾病[例(%)]
冠心病	31(26.27)	18(35.29)	1.408^b	0.235
高血压	78(66.10)	31(60.78)	0.440^b	0.507
糖尿病	22(18.64)	13(25.49)	1.016^b	0.313
高血脂	14(11.86)	9(17.65)	1.013^b	0.314
ASA分级(x±s>)	1.99±0.38	2.09±0.42	1.461^a	0.148
营养风险评分(x±s，分)	3.69±0.77	4.36±0.94	4.482^a	< 0.001
骨折类型[例(%)]			0.382^b	0.537
股骨颈骨折	61(51.69)	29(56.86)
股骨转子间骨折	57(48.31)	22(43.14)
手术类型[例(%)]			0.559^b	0.455
全髋关节置换术	37(31.36)	19(37.25)
髋关节内固定	81(68.64)	32(62.75)
注：^a为t值，^b为χ²值。

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表 2 死亡组和生存组髋部骨折患者的营养相关指标比较(x±s)

Table 2. Comparison of nutrition-related indexes between death group and survival group of patients with hip fracture(x±s)

组别	例数	血红蛋白(g/L)		白蛋白(g/dL)		前白蛋白(mg/L)		血肌酐(μmol/L)
组别	例数	术前1 d	出院时	术前1 d	出院时	术前1 d	出院时	术前1 d	出院时
生存组	118	109.68±10.65	118.84±12.07^b	34.26±6.46	42.84±7.13^b	243.36±34.46	289.55±40.37^b	48.45±7.84	62.15±9.46^b
死亡组	51	98.59±9.33	103.26±10.25^b	29.26±5.43	34.26±6.28^b	214.46±29.06	351.16±34.61^b	32.15±10.33	43.83±9.57^b
统计量		6.182^a	2.406^c	9.687^a	4.301^c	9.453^a	21.602^c	12.113^a	5.923^c
P值		< 0.001	0.018	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
注：^a为t值，^c为F值；与同组术前1 d比较，^bP < 0.05。

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表 3 髋部骨折不良预后的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of poor prognosis of hip fracture

变量	B	SE	Waldχ²	P值	OR值	95% CI
未校正
年龄	0.709	0.325	4.762	0.029	2.031	1.075~3.838
BMI值	-0.898	0.631	2.022	0.155	0.407	0.118~1.405
血红蛋白	-0.200	0.081	6.030	0.014	0.819	0.698~0.960
白蛋白	-0.548	0.259	4.460	0.035	0.578	0.348~0.961
前白蛋白	-2.210	1.037	4.540	0.033	0.110	0.014~0.838
血肌酐	-0.717	0.311	5.325	0.021	0.488	0.265~0.898
营养风险评分	0.151	1.093	0.019	0.890	1.164	0.137~9.912
校正年龄后
年龄	0.134	0.074	3.334	0.068	1.144	0.990~1.321
血红蛋白	-0.189	0.055	11.838	0.001	0.828	0.743~0.922
白蛋白	-0.273	0.095	8.290	0.004	0.761	0.632~0.916
前白蛋白	-0.751	0.261	8.305	0.004	0.472	0.283~0.786
血肌酐	-0.340	0.086	15.597	< 0.001	0.711	0.601~0.842

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表 4 营养相关指标预测髋部骨折不良预后的效能

Table 4. Effectiveness of nutrition-related indicators in predicting poor prognosis of hip fracture

项目	截断值	AUC	95% CI	灵敏度(%)	特异度(%)	准确率(%)	Youden指数
血红蛋白	104.47 g/L	0.852	0.789~0.902	84.3	78.0	79.29	0.622 8
白蛋白	28.37 g/dL	0.820	0.754~0.875	74.5	84.7	78.11	0.592 6
前白蛋白	14.77 mg/dL	0.844	0.780~0.895	80.4	78.8	80.47	0.592 1
血肌酐	40.10 μmol/L	0.929	0.880~0.963	88.2	84.7	86.39	0.729 8
联合预测		0.989	0.960~0.999	94.1	96.6	95.86	0.907 3

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