NT-proBNP对老年髋部骨折患者手术及保守治疗选择和预后的指导意义

发布时间：2018-05-14 00:12

  本文选题：血浆N末端B型利钠肽原 + 老年髋部骨折　； 参考：《广东医学》2017年05期

【摘要】：目的探讨老年髋部骨折患者血浆N末端B型利钠肽原(NT-proBNP)水平与疾病严重程度和治疗方案制定的可能关系,以及其对预后的预测价值。方法采用回顾性病例对照研究方法,分析髋部损伤科和重症医学科(ICU)收治的老年髋部骨折患者的临床资料,根据有无手术禁忌分为手术组、保守治疗组;根据6个月预后分为存活组和死亡组;根据患者体质状况对手术危险性分为ASAⅠ、Ⅱ、Ⅲ、Ⅳ级;根据血浆NT-proBNP水平分为正常组、低水平组、中等水平组、高水平组。纳入年龄≥65岁。收集患者入院第2天清晨血浆NT-proBNP值、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、ASA分级情况,并追踪统计6个月病死率。比较不同组间患者的基本资料,采用Pearson或Spearman相关法分析各参数间的相关性;采用受试者工作特征曲线(ROC)评估NT-proBNP对老年髋部骨折患者预后的评估价值。结果 (1)老年髋部骨折患者血浆NT-proBNP水平与APACHEⅡ评分呈显著正相关(r=0.831,P=0.000)。(2)保守治疗组血浆NT-proBNP水平和异常率以及APACHEⅡ评分、6个月病死率均较手术组显著升高(P0.01)。(3)死亡组年龄、血浆NT-proBNP水平及APACHEⅡ评分均较存活组显著升高(P0.05,P0.01)。(4)随ASA级别升高,NT-proBNP水平和6个月病死率逐渐升高(P0.01)。(5)随NT-proBNP水平升高,APACHEⅡ评分和6个月病死率逐渐升高(P0.01)。(6)NT-proBNP评估老年髋部骨折患者预后的ROC曲线下面积(AUC)为0.971[95%可信区间(95%CI)=0.939~1.000,P=0.000];当截点值为1 281.50 pg/m L时,预测患者6个月病死率的敏感度为100%,特异度为82.5%。结论老年髋部骨折患者血浆NT-proBNP水平与疾病严重程度呈正相关,可协助术前评估手术风险,对患者的预后有预测价值。
[Abstract]:Objective to investigate the possible relationship between plasma N-terminal B-type natriuretic peptide (NT-proBNPP) level and severity of the disease and the treatment plan in elderly patients with hip fracture and its prognostic value. Methods A retrospective case-control study was conducted to analyze the clinical data of elderly patients with hip fracture treated by Department of Hip injury and Department of intensive Medicine (ICU). The patients were divided into operation group and conservative treatment group according to the operative contraindications. According to the prognosis of 6 months, the patients were divided into survival group and death group, ASA 鈪，

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