老年股骨粗隆间骨折患者血清炎性介质的表达与患者预后的关系

发布时间：2018-02-15 13:59

本文关键词： 股骨粗隆骨折肿瘤坏死因子-α 白细胞介素- 白细胞介素-　出处：《中国老年学杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的探究老年股骨粗隆间骨折患者血清炎性介质表达与患者预后的关系。方法因股骨粗隆间骨折进入医院进行治疗的患者128例纳入研究组,同时选取未骨折的老年人100例作为对照组。研究组在入院时(t1)、麻醉开始时(t2)和术后1h(t3)、1d(t4)、3d(t5)、5d(t6)进行血清肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-10水平检测。对照组采集5 ml肘正中静脉血进行检测,项目同研究组患者。术后患者随访1年,记录患者发病、死亡情况。结果与对照组对比,研究组不同时间点TNF-α、IL-6及IL-10水平均较高(P0.05)。与t1时间点对比,研究组t3时TNF-α水平显著升高(P0.05),后逐步降低,t6时低于t1(P0.05)。t4~t5时IL-6达到最高,t6仍高于t1(P0.05)。t3时IL-10高于t1,t4~t5均为高峰,t6降至t1水平(P0.05)。Logistic回归分析结果表明患者TNF-α在术后1 d、3 d及IL-6在术后1 d能够作为老年股骨粗隆间骨折患者术后6个月的死亡危险因素。患者术后12个月随访,共死亡44例,存活84例。死亡病例术后3 d测定的血清TNF-α水平显著高于存活患者(P0.05);术后1、3、5 d测定血清IL-6水平显著高于存活患者(P0.05);死亡病例血清IL-10水平在术后1、3 d时高于存活患者(P0.05)。Logistic回归分析结果表明术后12个月死亡危险因素为IL-6术后1 d、IL-10术后1 d水平,并发症发病危险因素为术后1 d时IL-6水平。结论老年患者因股骨粗隆间骨折进行手术时,能够使其血清TNF-α、IL-6、IL-10水平显著提高,但炎症反应过度,因子水平较高使得患者预后不佳,在患者手术及住院期间进行炎性介质水平检测,能够及时捕捉到病情变化情况,便于早期处理,改善患者预后效果。
[Abstract]:Objective to investigate the relationship between the expression of serum inflammatory mediators and the prognosis of elderly patients with intertrochanteric fractures. Methods 128 patients with intertrochanteric fractures admitted to hospital for treatment were included in the study group. At the same time, 100 elderly patients without fracture were selected as the control group. The serum TNF- 伪 and IL-6IL-10 levels were measured in the study group at admission, at the beginning of anesthesia (t _ 2) and 1 hour after operation. The median positive vein blood samples were collected from the control group, and the serum levels of TNF- 伪 and IL-6IL-10 were measured. The patients in the study group were followed up for 1 year to record the morbidity and mortality. Results compared with the control group, the levels of TNF- 伪 IL-6 and IL-10 in the study group were higher than those in the control group at different time points (P 0.05). The level of TNF- 伪 increased significantly in the study group at t 3, then decreased gradually, and then decreased gradually. When the IL-6 reached the highest level at the time of t1, P0. 05, T4, T5, still higher than that of t1, P0. 05, t3, IL-10, higher than that of t1, t4, t5, the results of logistic regression analysis showed that TNF- 伪 decreased to T1 on the 3rd day after operation and IL-6 was higher than that of T1T4, T4, T5, TNF- 伪 and TNF- 伪. One day after operation could be used as a risk factor of death in elderly patients with intertrochanteric fracture of femur 6 months after operation. The patients were followed up 12 months after operation. 44 cases died, The levels of serum TNF- 伪 in dead patients were significantly higher than those in surviving patients 3 days after operation, and the levels of serum IL-6 were significantly higher than those in surviving patients on the 1st and 3rd day after operation, and the levels of serum IL-10 in dead patients were higher than those in surviving patients at 1 and 3 days after operation. Logistic regression analysis showed that the risk factor of death at 12 months after IL-6 was the level of IL-10 1 day after IL-6. Conclusion the serum TNF- 伪 IL-6 IL-10 level was significantly increased in elderly patients with intertrochanteric fracture of femur, but the inflammatory reaction was excessive, and the prognosis of the elderly patients was not good because of the high level of cytokines. The detection of inflammatory mediators during operation and hospitalization can catch the state of disease in time, facilitate early treatment and improve the prognosis of patients.
【作者单位】：新疆维吾尔自治区中医医院骨四科;新疆维吾尔自治区中医医院骨二科;
【分类号】：R683.4

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