老年髋部骨折患者术前血清白蛋白及淋巴细胞总数改变对其预后的影响

Effect of pre-operative serum albumin level and total lymphocyte count on outcomes of elderly patients with hip fracture

摘要:

目的 探讨术前血清白蛋白（ALB）及淋巴细胞总数(TLC)改变对老年髋部骨折预后的影响。方法 回顾性地分析2006年7月至2010年12月在解放军总医院行手术治疗老年髋部骨折的640例患者的临床资料。分别于入院时检测ALB和TLC。临床随访指标包括患者住院时间、住院并发症、住院死亡率、术后3个月死亡率、术后12个月死亡率。将所得资料行多因素统计分析，评价ALB和TLC的变化对患者预后的临床意义。结果 640例患者中低ALB患者283例（44.2%），低TLC患者435例（68%）。ALB和TLC均低于正常值者，术后并发症发生率为13.3%，住院死亡率、术后3个月死亡率、术后1年死亡率分别为4.2%、6.7%、16.7%，均明显高于其他各组（P＜0.05）。多因素分析显示ALB及TLC可作为老年髋部骨折患者死亡风险的预测因素。结论 老年髋部骨折患者入院时营养不良可预测术后不良临床结局，ALB及TLC可以作为患者营养不良及不良临床结局的预测因素。

Abstract:

Objective To determine the effect of pre-operative serum albumin (ALB) level and total lymphocyte count (TLC) on the prognosis of hip fracture in the elderly patients. Methods Clinical data of 640 elderly patients (over 60 years old) with hip fracture undergoing surgical treatment in our department from July 2006 to December 2010 were collected and retrospectively analyzed in this study. Their serum ALB level and TLC were recorded at admission. Their hospitalization time, in-hospital complications, and mortality at hospital and at 3 and 12 months after surgery were analyzed. Cox regression analysis was carried out on these data. The clinical significance of serum ALB level and TLC was evaluated in the prediction of prognosis. Results Among the 640 patients, those with lower serum ALB level accounted for 44.2% (283), and those with lower TLC accounted for 68.0% (435). The patients with lower albumin and lower TLC had higher incidence of postoperative complications (13.3%), and higher mortalities at hospital (4.3%), 3-month (6.7%) and 12-month (16.7%) post-operatively compared to the patients who had normal values of the 2 laboratory parameters (all P＜0.05). Cox regression analysis indicated that serum ALB and TLC were predictive factors for mortality risk in the elderly with hip fracture. Conclusion Malnutrition at admission indicates poor clinical outcome after surgical treatment in the elderly patients with hip fracture. Lower serum ALB level and TLC are regarded as predictive factors for malnutrition and poor prognosis in these patients.