术前血清白蛋白及淋巴细胞总数改变对老年髋部骨折预后的影响1.docVIP

·临床研究· 术前血清白蛋白及淋巴细胞总数改变对老年髋部骨折预后的影响1 李 佳1，龙安华1,2，张里程1，唐佩福1 （1解放军总医院骨科，北京 100853；2南开大学医学院，天津 300071） 【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 回顾性分析2006年7月至2010年12月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月死亡率、术后1年死亡率分别为4.3%、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。 【关键词】老年髋部骨折、营养不良、白蛋白、淋巴细胞计数 【中图分类号】 R641 【文献标识码】 A 【DOI】 ? Effect of serum albumin and total lymphocyte count on outcomes in elderly hip fracture patients LI Jia1, LONG An-Hua1,2, ZHANG Li-Cheng1, TANG Pei-Fu1 (1Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China; 2School of Medicine, Nankai University, Tianjin 300071, China) 【Abstract】 Objective To determine the effect of serum albumin (ALB) level and total lymphocyte count (TLC) on the prognosis of hip fracture in aged 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 retrospective analyzed in this study. Their serum ALB level and TLC were recorded at admission. Their hospital time, hospital complications, and mortality at hospital and in 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 ha