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术前血C反应蛋白与白蛋白比值、老年营养风险指数在老年髋部骨折患者预后评估中的价值
作者：赵改  谢杰  刘飞  宁仁德 
单位：合肥市滨湖医院/安徽医科大学第三附属医院 关节骨科, 安徽 合肥 230001
关键词：C反应蛋白/白蛋白比值 老年营养风险指数 髋部骨折 预后 
分类号：R683.3
出版年·卷·期（页码）：2021·40·第一期（103-107）
摘要：

目的：探讨术前血C反应蛋白（CRP）与白蛋白比值（CAR）、老年营养风险指数（GNRI）在老年髋部骨折患者预后评估中的价值。方法：回顾性分析2016年1月至2019年1月在本科接受治疗的135例老年髋部骨折患者的临床资料，根据患者术后1年有无死亡分为预后不良组（n=42）和预后良好组（n=93）。采用多因素Logistic回归分析影响老年髋部骨折患者预后不良的危险因素；采用受试者工作特征（ROC）曲线分析CAR、GNRI对老年髋部骨折患者不良预后的诊断效能。结果：单因素分析显示，预后不良组的年龄、APACHEⅡ评分、ASA分级、CRP、白蛋白、CAR及GNRI与预后良好组相比，差异均有统计学意义（P<0.05）。多因素Logistic回归分析显示，年龄、APACHEⅡ评分、ASA分级、CRP、白蛋白、CAR和GNRI是老年髋部骨折患者预后不良的重要危险因素（P<0.05）。CAR、GNRI和两项联合检测预测老年髋部骨折患者预后不良的曲线下面积为0.897、0.878和0.952。结论：CAR升高、GNRI降低是老年髋部骨折患者预后不良的重要危险因素，CAR和GNRI联合预测老年髋部骨折患者不良预后的价值更高，可作为临床评估老年髋部骨折术后患者预后风险的参考指标。

Objective: To explore the value of preoperative C-reactive protein(CRP)/albumin ratio (CAR) and Geriatric Nutritional Risk Index (GNRI) in the prognostic evaluation of elderly patients with hip fracture. Methods: A retrospective analysis of the clinical data of 135 elderly hip fractures treated in our department from January 2016 to January 2019. The patients were divided into poor prognosis group (n=42) and good prognosis group (n=93) according to whether they died within 1 year after operation. Multivariate Logistic regression was used to analyze the risk factors that affected the prognosis of elderly patients with hip fracture. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of CAR and GNRI for the poor prognosis of elderly patients with hip fracture. Results: Univariate analysis showed that the age, APACHEⅡ score, ASA classification, CRP, albumin, CAR and GNRI of the poor prognosis group were significantly different from those of the good prognosis group (P<0.05). Multivariate logistic regression analysis showed that age, APACHEⅡ score, ASA classification, CRP, albumin, CAR and GNRI were important risk factors for poor prognosis in elderly patients with hip fracture (P<0.05). The area under the curve for CAR, GNRI and the two combined tests to predict poor prognosis of elderly patients with hip fracture was 0.897, 0.878 and 0.952. Conclusion: Increased CAR and decreased GNRI are important risk factors for poor prognosis in elderly patients with hip fractures. The combined detection of CAR and GNRI is more valuable in predicting the poor prognosis of elderly patients with hip fractures, which can be used as a reference index for clinical evaluation of the prognosis risk of elderly patients with hip fracture after surgery.
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