术前控制营养状况评分及单核细胞/淋巴细胞值对老年髋部骨折患者预后的预测价值-东南大学学报医学版

术前控制营养状况评分及单核细胞/淋巴细胞值对老年髋部骨折患者预后的预测价值

单位：空军军医大学唐都医院骨科, 陕西西安 710038

分类号：R683

出版年·卷·期（页码）：2022·41·第三期（379-385）

摘要：

目的：探讨术前控制营养状况（CONUT）评分及单核细胞/淋巴细胞值（MLR）对老年髋部骨折患者预后的预测价值。方法：选取2015年1月至2019年1月在本科接受手术治疗的140例老年髋部骨折患者，根据患者术后1年的生存情况分为生存组（n=101）与死亡组（n=39）。收集老年髋部骨折患者的临床资料，包括年龄、性别、体质量指数、美国麻醉医师协会（ASA）分级及实验室检查指标等。采用Cox比例风险模型分析影响老年髋部骨折患者临床预后的危险因素。应用ROC曲线分析术前CONUT评分、MLR对老年髋部骨折患者不良预后的预测价值。结果：死亡组急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、ASA分级、CONUT评分、MLR与生存组相比，差异均有统计学意义（P<0.05）。Cox多因素分析结果示，ASAⅢ~Ⅳ级、APACHEⅡ评分升高、术前CONUT评分升高和MLR升高是影响老年髋部骨折患者不良预后的独立危险因素（P<0.05）。ROC曲线显示，联合CONUT评分、MLR预测老年髋部骨折患者不良预后的曲线下面积（AUC）为0.904，敏感度和特异度分别为0.695、0.906。高CONUT评分、MLR组患者生存率分别低于低CONUT评分、MLR组患者生存率，差异均有统计学意义（P<0.05）。结论：术前CONUT评分、MLR升高是老年髋部骨折患者预后不良的重要危险因素，联合CONUT评分、MLR对评估患者临床预后有较高参考价值。

Objective: To explore the predictive value of preoperative control nutritional status(CONUT) score and monocyte/lymphocyte ratio(MLR) in the prognosis of elderly patients with hip fracture. Methods: A total of 140 elderly patients with hip fractures who underwent surgical treatment in our department from January 2015 to January 2019 were selected. The patients were divided into survival group(n=101) and death group(n=39) according to their 1-year survival. Clinical data of elderly patients with hip fracture were collected, including age, gender, body mass index, ASA classification and laboratory examinations. The Cox proportional hazard model was used to analyze the risk factors affecting the clinical prognosis of elderly patients with hip fracture. The ROC curve was used to analyze the predictive value of preoperative CONUT score and MLR for the poor prognosis of elderly patients with hip fracture. Results: Compared with the survival group, the APACHEⅡ score, ASA classification, CONUT score, and MLR of the death group had statistically significant differences(P<0.05). Cox multivariate analysis showed that the ASA grade(grade Ⅲ-Ⅳ), the increase of APACHEⅡ score, the increase of preoperative CONUT score and MLR value were independent risk factors affecting the poor prognosis of elderly patients with hip fracture(P<0.05). The ROC curve showed that the combined detection of CONUT score and MLR predicted the poor prognosis of elderly hip fracture patients, with AUC 0.904, sensitivity 0.695, and specificity 0.906. The survival rates of patients in the high CONUT score and MLR groups were lower than those in the low CONUT score and MLR groups, respectively, and the difference was statistically significant(P<0.05). Conclusion: The preoperative CONUT score and MLR increase are important risk factors for the poor prognosis of elderly patients with hip fracture. The combined detection of CONUT score and MLR has a high reference value for evaluating the clinical prognosis of patients.

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