目的探讨老年股骨转子间骨折患者术前心力衰竭的相关危险因素及其预测效能。
方法采用回顾性队列研究分析2018年7月至2022年7月南京大学医学院附属鼓楼医院收治的163例老年股骨转子间骨折患者的临床资料，其中男57例，女106例；年龄63~98岁［83.3（78.0，87.0）岁］。按照入院24 h内首次血清B型利钠肽（BNP）是否超过100 pg/ml，将患者分为心力衰竭高危组（66例）和非高危组（97例）。收集2组性别、年龄、骨折AO分型、骨折侧别、合并基础疾病（糖尿病、心血管疾病、脑梗死）、既往骨折史、既往手术史、受伤至入院时间<48 h、入院首次血压、入院首次血常规检查［白细胞计数（WBC）、中性粒细胞计数（NEUT）、淋巴细胞计数、血小板计数（PLT）、血红蛋白（Hb）］、入院首次血生化检查［谷丙转氨酶（ALT）、谷草转氨酶（AST）、乳酸脱氢酶（LDH）、白蛋白、血糖、血钙、肌酐、肾小球滤过率（GFR）］、入院首次其他相关检查［D-二聚体、凝血酶原时间（PT）、C-反应蛋白（CRP）］。通过单因素和二元Logistic回归分析筛选老年股骨转子间骨折患者术前心力衰竭的独立危险因素。绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC），评估各独立危险因素单独或两两联合对老年股骨转子间骨折患者术前心力衰竭的预测效能。
结果单因素分析结果显示，年龄、合并心血管疾病、既往骨折史、受伤至入院时间<48 h、Hb、肌酐和GFR与老年股骨转子间骨折患者术前心力衰竭有一定的相关性（ P<0.05），而性别、骨折AO分型、骨折侧别、糖尿病、脑梗死、既往手术史、血压、WBC、NEUT、淋巴细胞计数、PLT、CRP、ALT、AST、LDH、白蛋白、血糖、血钙、D-二聚体、PT及CRP与老年股骨转子间骨折患者术前心力衰竭不相关（ P>0.05）。Logistic回归分析结果表明，年龄（95% CI 1.02，1.15， P<0.05）、合并心血管疾病（95% CI 1.31，5.88， P<0.01）、Hb（95% CI 0.96，1.00， P<0.05）和GFR（95% CI 0.97，1.00， P<0.05）是老年股骨转子间骨折患者术前心力衰竭的独立危险因素。ROC曲线分析结果表明，年龄、合并心血管疾病、Hb和GFR对老年股骨转子间骨折患者术前心力衰竭均有预测作用，其中合并心血管疾病联合GFR的预测能力较强（AUC=0.76，95% CI 0.68，0.84）。
结论年龄、合并心血管疾病、Hb和GFR是老年股骨转子间骨折患者术前心力衰竭的独立危险因素；合并心血管疾病联合GFR对老年股骨转子间骨折患者术前心力衰竭预测效能较高。
ObjectiveTo investigate the risk factors associated with preoperative heart failure in elderly patients with intertrochanteric fracture and evaluate their predictive efficacy.
MethodsA retrospective cohort study was conducted to analyze the clinical data of 163 elderly patients with intertrochanteric fracture admitted to the Affiliated Drum Tower Hospital of Nanjing University School of Medicine from July 2018 to July 2022, including 57 males and 106 females, aged 63-98 years [83.3(78.0, 87.0)years]. The patients were divided into high-risk heart failure group ( n=66) and non-high-risk group ( n=97) based on whether the serum B-type natriuretic peptide (BNP) level within 24 hours on admission was greater than 100 pg/ml. The following data in the two groups were collected, including gender, age, AO/OTA fracture classification, fracture laterality, associated underlying comorbidities (diabetes, cardiovascular diseases, cerebral infarction), past history of fracture, history of surgeries, time from injury to hospitalization less than 48 hours, first blood pressure on admission, first routine blood test on admission [leukocyte count (WBC), neutrophil count (NEUT), lymphocyte count, platelet (PLT), hemoglobin (Hb)], first blood biochemistry on admission [alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), albumin, glucose, serum calcium, creatinine, glomerular filtration rate (GFR), and first other related tests on admission [D-dimer, prothrombin time (PT), C-reactive protein (CRP)]. Independent risk factors for preoperative heart failure in elderly patients with intertrochanteric fracture were identified through univariate analysis and binary logistic regression analysis. The predictive efficacy of each indicator or two combined indicators for preoperative heart failure in elderly patients with intertrochanteric fractures was assessed by plotting the receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC).
ResultsUnivariate analysis demonstrated that age, associated cardiovascular diseases, history of fracture, time from injury to hospitalization less than 48 hours, Hb, creatinine and GFR were significantly correlated with the preoperative heart failure ( P<0.05), while gender, AO/OTA fracture classification, fracture laterality, diabetes, cerebral infarction, history of surgeries, blood pressure, WBC, NEUT, lymphocyte count, PLT, CRP, ALT, AST, LDH, albumin, glucose, serum calcium, D-dimer, PT, and CRP were not correlated with the preoperative heart failure in elderly patients with intertrochanteric fractures ( P>0.05). Logistic regression analysis revealed that age (95% CI 1.02, 1.15, P<0.05), associated cardiovascular disease (95% CI 1.31, 5.88, P<0.01), Hb (95% CI 0.96, 1.00, P<0.05), and GFR (95% CI 0.97, 1.00, P<0.05) were independent risk factors for heart failure in elderly patients with intertrochanteric fracture. ROC curve analysis demonstrated that age, associated cardiovascular diseases, Hb, and GFR could predict preoperative heart failure in elderly patients with intertrochanteric fractures, with the combination of associated cardiovascular disease and GFR showing a relatively higher predictive ability (AUC=0.76, 95% CI 0.68, 0.84).
ConclusionsAge, associated cardiovascular diseases, Hb and GFR are independent risk factors for preoperative heart failure in elderly patients with intertrochanteric fracture. Moreover, the combination of associated cardiovascular diseases and GFR possesses a relatively higher predictive value for preoperative heart failure in elderly patients with intertrochanteric fracture.
钱玺文,孟晓,孟唯浩,等. 老年股骨转子间骨折患者术前心力衰竭的相关危险因素及其预测效能分析[J]. 中华创伤杂志,2025,41(03)：267-273.
DOI:10.3760/cma.j.cn501098-20241227-00726版权归中华医学会所有。
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钱玺文：数据采集、统计学分析、论文撰写；孟晓、孟唯浩：数据采集；李雨河、韩成华：数据整理；张子韬：论文修改及审定、经费支持
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