| 摘要: |
| ［摘要］ 目的 分析老年髋部骨折患者骨密度特征及并发衰弱危险因素。方法 回顾性分析2021年9月至11月首都医学大学附属北京积水潭医院收治的267例老年髋部骨折患者的临床资料，根据衰弱筛查5项评分量表评估结果，并发衰弱者110例（衰弱组），未并发衰弱者157例（非衰弱组）。比较两组定量CT（QCT）测得的髋部体积骨密度（vBMD）结果以及人口学特征、Charlson合并症指数（CCI）评分、小腿围、纤维蛋白原与前白蛋白比值（FPR）、骨代谢生化标志物、肌少症风险等临床资料。采用多因素logistic回归分析影响老年髋部骨折患者并发衰弱的因素。结果 衰弱组年龄、FPR、Ⅰ型胶原C端肽交联β降解产物（β-CTX）、总Ⅰ型前胶原N端前肽（tP1NP）水平，以及存在营养风险、存在肌少症风险及CCI评分>2分的人数比例高于非衰弱组，体质量指数、游离三碘甲状腺原氨酸（FT3）、小腿围、全髋松质骨vBMD（THT vBMD）、股骨颈松质骨vBMD（FNT vBMD）、粗隆间松质骨vBMD（ ITT vBMD）以及血清25羟基维生素D3［25-（OH）D3］水平低于非衰弱组，差异有统计学意义（P<0.05）。分层分析结果显示，女性患者中，衰弱组THT vBMD、FNT vBMD水平显著低于非衰弱组（P<0.05）。男性患者中，衰弱组仅THT vBMD水平显著低于非衰弱组（P<0.05）。多因素logistic回归分析结果显示，较大的年龄，β-CTX、FPR水平升高，存在营养风险以及CCI评分>2分是促进衰弱发生的独立危险因素（P<0.05），小腿围、THT vBMD、25-（OH）D3水平增高是抑制衰弱发生的保护因素（P<0.05）。结论 老年髋部骨折合并衰弱患者髋关节骨密度以THT vBMD、FNT vBMD、ITT vBMD减低为特征，除年龄、营养状况、小腿围、共病因素外，骨代谢生化标志物β-CTX及25-（OH）D3亦与衰弱显著相关，临床医师应对此予以关注，及早进行分层管理，以改善患者预后。 |
| 关键词: 髋部骨折 衰弱 骨密度 骨代谢生化标志物 危险因素 定量CT |
| DOI：10.3969/j.issn.1674-3806.2025.01.09 |
| 分类号:R 683.3 |
| 基金项目: |
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| Analysis on the bone mineral density characteristics and the risk factors of concurrent frailty in elderly patients with hip fractures |
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CHEN Zhifang1, YU Xiaohong2, MA Kangkang3
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1.Department of Prevention and Health Care, Beijing Jishuitan Hospital, Captial Medical University, Beijing 100035, China; 2.Department of Emergency Medicine, Beijing Jishuitan Hospital, Captial Medical University, Beijing 100035, China; 3.Department of Radiology, Beijing Jishuitan Hospital, Captial Medical University, Beijing 100035, China
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| Abstract: |
| ［Abstract］ Objective To analyze the bone mineral density characteristics and the risk factors of concurrent frailty in elderly patients with hip fractures. Methods The clinical data of 267 elderly patients with hip fractures who were admitted to Beijing Jishuitan Hospital, Captial Medical University from September 2021 to November 2021 were retrospectively analyzed, and according to the evaluation results of the 5-item FRAIL scale, the patients were divided into frail group(with concurrent frailty, 110 cases) and non-frail group(without concurrent frailty, 157 cases). The results of hip joint volumetric bone mineral density(vBMD) measured by quantitative computed tomography(QCT) were compared between the two groups, as well as the clinical data including demographic characteristics, Charlson comorbidity index(CCI) scores, calf circumference, fibrinogen-to-prealbumin ratio(FPR), biochemical markers of bone metabolism and risk of sarcopenia. Multivariate logistic regression was used to analyze the factors influencing concurrent frailty in the elderly patients with hip fractures. Results The frail group was older than the non-frail group, and the levels of FDR beta-isomerized C-terminal telopeptide of type Ⅰ collagen(β-CTX), total procollagen type Ⅰ N-terminal propeptide(tP1NP), as well as the proportion of the patients with nutritional risk, risk of sarcopenia and CCI scores>2 points in the frail group were higher than those in the non-frail group, and the levels of body mass index(BMI), free triiodothyronine(FT3), calf circumference, trabecula vBMD of the total hip bone(THT vBMD), trabecula vBMD of the femoral neck(FNT vBMD), trabecula vBMD of the intertrochanter(ITT vBMD) and serum 25-(OH)D3 in the frail group were lower than those in the non-frail group, and the differences were statistically significant(P<0.05). The results of stratified analysis showed that in the female patients, the levels of THT vBMD and FNT vBMD in the frail group were significantly lower than those in the non-frail group(P<0.05), and in the male patients, only THT vBMD levels in the frail group were significantly lower than those in the non-frail group(P<0.05). The results of multivariate logistic regression analysis showed that older age, elevated levels of β-CTX and FPR, as well as nutritional risk and CCI scores greater than 2 points were independent risk factors for promoting the occurrence of frailty, while elevated levels of calf circumference, THT vBMD, and 25-(OH)D3 were protective factors for inhibiting the occurrence of frailty(P<0.05). Conclusion Hip bone mineral density in elderly patients with hip fractures and concurrent frailty is characterized by reduced THT vBMD, FNT vBMD, and ITT vBMD. In addition to the factors of age, nutritional status, calf circumference and comorbidities, biochemical markers of bone metabolism β-CTX and 25-(OH)D3 are also significantly associated with frailty. Clinicians should pay attention to these factors and conduct stratified management as soon as possible to improve the prognosis of the patients. |
| Key words: Hip fractures Frailty Bone mineral density Biochemical markers of bone metabolism Risk factor Quantitative computed tomography(QCT) |
