红细胞体积分布宽度与老年髋部骨折病人预后的关系  

Relationship between red blood cell volume distribution width and prognosis of elderly patients with hip fracture

作　　者：张明 陈曦[1] 刘跃洪[1] 谢德[1] 王志聪 兰平文[1] 王光林[2] ZHANG Ming;CHEN Xi;LIU Yuehong;XIE De;WANG Zhicong;LAN Pingwen;WANG Guanglin(Orthopaedic Center of Deyang/Department of Orthopaedics,Deyang People’s Hospital,Deyang 618000,China;Department of Orthopedic Surgery,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]德阳市人民医院骨科/德阳市骨科中心,四川省德阳市618000 [2]四川大学华西医院骨科,四川省德阳市610041

出　　处：《实用老年医学》2024年第1期22-27,共6页Practical Geriatrics

基　　金：四川省卫生健康委员会科研课题(20PJ249);德阳市科技计划项目(2019SZ040)。

摘　　要：目的 探讨红细胞体积分布宽度(RDW)与老年髋部骨折病人预后的关系。方法 登陆我院建立的老年髋部骨折数据库,纳入2014年1月至2021年3月收治的926例病人为研究对象,提取这些病人的临床资料和相关实验室检查结果。绘制RDW预测老年髋部骨折病人预后的ROC曲线,根据RDW的最佳截断值将病人分为高、低RDW组,并对比2组的基本临床资料。随访病人的生存情况,绘制并比较2组的Kaplan-Meier生存曲线。采用Cox比例风险模型分析影响老年髋部骨折病人预后的危险因素,并进行贫血及非贫血的分层分析。结果 RDW预测老年髋部骨折病人预后的最佳截断值为14.40%。926例病人中,低RDW组(RDW≤14.40%)661例,高RDW组(RDW>14.40%)265例,2组年龄、性别、骨折类型、输血比例、贫血比例、Charlson合并症指数(CCI)分级、伤后至入院时间、血红蛋白、白蛋白水平差异有统计学意义(P<0.05或P<0.01)。所有病人中位随访43.68个月,高RDW组30 d、6个月和1年死亡率均高于低RDW组(P<0.05或P<0.01)。多因素Cox回归分析显示,RDW>14.40%、高龄、男性、CCI≥1、保守治疗、低白蛋白是老年髋部骨折病人1年内死亡的独立危险因素(均P<0.05)。进一步对贫血进行分层分析发现:在非贫血病人中,RDW>14.40%与老年髋部骨折病人的1年死亡风险独立相关(HR=2.969,95%CI:1.478~5.963,P=0.002),而在贫血病人中,二者无相关性(P=0.259)。结论 RDW与非贫血老年髋部骨折病人的预后密切相关。Objective To investigate the relationship between red blood cell volume distribution width(RDW)and prognosis of elderly patients with hip fracture.Methods The clinical data and laboratory test results of 926 elderly patients with hip fractures admitted to our hospital from January 2014 to March 2021 were collected.The receiver operating characteristic(ROC)curve of RDW predicting the prognosis of the elderly patients with hip fractures was drawn.All patients were divided into the high RDW group and the low RDW group according to the optimal cut-off value of RDW.The basic clinical data were compared between the two groups.Survival situation was obtained from telephone follow-up,and the Kaplan-Meier survival curves of the two groups were plotted and compared.Cox proportional hazards model was used to analyze the risk factors for the prognosis of the elderly patients with hip fractures,and stratified analysis was performed for anemia and non-anemia.Results The optimal cut-off value of RDW was 14.40%.A total of 661 patients presented with low RDW(RDW≤14.40%)and 265 patients with high RDW(RDW>14.40%).There were significant differences in age,gender,fracture type,blood transfusion,anemia,Charlson comorbidity index(CCI),time from injury to admission,hemoglobin and albumin levels between the two groups(P<0.05 or P<0.01).The median follow-up time was 43.68 months.Compared with the low RDW group,the high RDW group showed higher 30-day,6-month and 1-year mortality rate(P<0.05 or P<0.01).Multivariate Cox regression analysis showed that RDW>14.40%,advanced age,male,CCI≥1,conservative treatment and low albumin were the independent risk factors for 1-year mortality of the elderly patients with hip fracture(all P<0.05).The stratified analysis showed a strong independent association between RDW>14.40%and 1-year risk of death in the non-anemic elderly patients with hip fracture(HR=2.969,95%CI:1.478-5.963,P=0.002),but there was no association in the patients with anemia(P=0.259).Conclusions RDW is closely related to the prognosi

关 键 词：红细胞体积分布宽度 髋部骨折 老年人 预后 贫血 

分 类 号：R683.3[医药卫生—骨科学]