老年骨折并发急性脑血管创伤预后调查分析及Nomogram预测模型构建  

Investigation and analysis of prognosis of elderly fracture complicated with acute cerebrovascular trauma and construction of Nomogram predictive model

作　　者：邹保林 王玉荣 汪钊 赵泉勇[3] 李巧静 安娜[2] ZOU Baolin;WANG Yurong;WANG Zhao;ZHAO Quanyong;LI Qiaojing;AN Na(Emergency Department,Tangshan Second Hospital,Tangshan Hebei 063000,China)

机构地区：[1]唐山市第二医院急诊科,河北唐山063000 [2]唐山市第二医院护理部,河北唐山063000 [3]唐山市第二医院创五科,河北唐山063000 [4]唐山市第二医院内科,河北唐山063000

出　　处：《中国急救复苏与灾害医学杂志》2024年第6期786-790,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省医学科学研究重点课题计划项目(项目:20211177)。

摘　　要：目的探讨老年骨折并发急性脑血管创伤患者的预后,调查分析其危险因素并构建Nomogram预测模型。方法纳入2021年1月—2023年1月于唐山市第二医院接受治疗的98例老年骨折患者的临床资料,将老年骨折患者并发急性脑血管创伤者纳入观察组,未并发急性脑血管创伤者纳入对照组,比较两组基线资料和实验室指标,采用Logistic回归分析明确老年骨折并发急性脑血管创伤的独立影响因素,将获得的独立影响因素纳入Nomogram预测模型构建,采用R软件中C指数、受试者工作特征(ROC)曲线及校准曲线评价老年骨折并发急性脑血管创伤风险的Nomogram模型的预测效能。结果两组性别、年龄、身体质量指数(BMI)、骨折时间、高血压、吸烟史以及饮酒史对比无统计学差异(P>0.05);观察组高血糖患者比例明显多于对照组(P<0.05)。两组实验室指标对比中,收缩压、舒张压、空腹血糖(FPG)、总胆固醇(TC)、红细胞计数(RBC)、白细胞计数(WBC)、三酯甘油(TG)、钠离子、钾离子、钙离子以及D-二聚体无统计学差异(P>0.05);观察组RBC低于对照组,观察组血小板、纤维蛋白原(FIB)和C-反应蛋白(CRP)高于对照组(P<0.05)。Logistics回归分析显示,RBC是老年骨折并发急性脑血管创伤的独立保护因素(OR<1,P<0.05);高血糖、血小板、FIB和CRP是老年骨折并发急性脑血管创伤的独立危险因素(均OR>1,均P<0.05)。ROC曲线分析结果显示,高血糖、RBC、血小板、FIB以及CRP的AUC值均>0.700,表明上述指标对于老年骨折是否并发急性脑血管创伤具有较好的预测价值。基于以上影响因素构建Nomogram风险模型,校准曲线C-index值为0.964,说明该Nomogram模型具备较好的区分度,ROC曲线建模组和验证组的AUC值分别为0.964和0.939,说明该Nomogram模型具有良好的预测效能。结论基于老年骨折并发急性脑血管创伤的独立影响因素构建的Nomogram预测模型,能直观地预�Objective To explore the prognosis of senile fracture patients complicated with acute cerebrovascular trauma,investigate and analyze its risk factors,and build a Nomogram predictive model.Methods The clinical data of 98 elderly fracture patients treated in our hospital from January 2021 to January 2023 were included.The elderly fracture patients complicated with acute cerebrovascular trauma were classified as the observation group and those without acute cerebrovascular trauma as the control group.The baseline data and laboratory indicators of the two groups were compared,and the independent influencing factors of elderly fracture complicated with acute cerebrovascular trauma were determined by Logistic regression analysis.The obtained independent influencing factors were incorporated into the construction of Nomogram predictive model,and the effectiveness of Nomogram model for the risk of elderly fracture complicated with acute cerebrovascular trauma was evaluated by C index,receiver's working characteristic(ROC)curve and calibration curve in R software.Results There was no difference in sex,age,body mass index(BMI),fracture time,hypertension,smoking history and drinking history between the two groups(P>0.05).The hyperglycemia in the observation group was significantly higher than that in the control group(P<0.05).There was no difference in systolic blood pressure,diastolic blood pressure,fasting blood glucose(FPG),total cholesterol(TC),red blood cell count(RBC),white blood cell count(WBC),triglyceride(TG),sodium ion,potassium ion,calcium ion and D-dimer between the two groups(P>0.05).The RBC in the observation group was lower than that in the control group,and the platelet fibrinogen(FIB)and C-reactive protein(CRP)in the observation group were higher than those in the control group(P<0.05).Logistics regression analysis showed that RBC was an independent protective factor for elderly fracture complicated with acute cerebrovascular trauma(OR<1,P<0.05).Hyperglycemia,platelet,FIB and CRP were independent risk facto

关 键 词：老年骨折 急性脑血管创伤 影响因素 Nomogram预测模型 

分 类 号：R683[医药卫生—骨科学] R6512[医药卫生—外科学]