生物可利用25(OH)D、甲状旁腺素对老年髋部骨折术后功能恢复的影响
The effect of bioavailable 25-(OH) D and parathyroid hormone levels on functional recovery in elderly patients with hip fractures
  
DOI:10.3969/j.issn.1006-7108.2023.09.003
中文关键词:  脆性髋部骨折  老年人  生物可利用25(OH)D
英文关键词:fragility hip fracture  elderly  bioavailable 25-(OH)D
基金项目:国家自然科学基金项目(81971829)
作者单位
刘亚枫 刘宝哲 李建军 巴根* 中国医科大学附属盛京医院第五骨科创伤病房,辽宁 沈阳 110000 
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中文摘要:
      目的 研究生物可利用25(OH)D、甲状旁腺素对老年脆性髋部骨折术后功能恢复的影响。方法 采用前瞻性队列研究,收集我院2017年5月至2021年11月318例老年髋部骨折患者,选取同时期在体检中心参加体检的健康人为对照组,采用自行设计调查问卷进行调查,检测钙、白蛋白、维生素D结合蛋白、总25(OH)D、甲状旁腺素水平,计算生物可利用25(OH)D水平。随访评价髋部骨折患者术后功能表现,采用多因素Logistic回归模型分析生物可利用25(OH)D、甲状旁腺素与老年脆性髋部骨折功能的相关性。采用受试者工作曲线下面积(receiver operating characteristic,ROC)研究生物可利用25(OH)D、甲状旁腺素与老年脆性髋部骨折术后功能的预测价值。结果 本研究共纳入318名患者,总25(OH)D(OR=0.866,95 %CI:0.834~0.899,P<0.001)、生物可利用25(OH)D(OR=0.775,95 %CI:0.655~0.917,P=0.003)和甲状旁腺素(OR=1.909,95 %CI:0.852~0.969,P=0.004)与康复效果有关。ROC曲线分析结果显示,总25(OH)D、生物可利用25(OH)D和甲状旁腺素的曲线下面积分别为 0.826、0.644和0.579。结论 高总25-(OH)D、高生物可利用25(OH)D、低甲状旁腺素水平促进老年髋部脆性骨折术后功能恢复。
英文摘要:
      Objective To investigate the effect of bioavailable 25-(OH) Dand parathyroid hormone levels on functional recovery in elderly patients with brittle hip fractures after surgery. Methods A prospective cohort study of 318 adult patients with hip fractures from May 2017 to November 2021 in our hospital was enrolled. Levels of total 25-(OH)D, parathyroid hormone, calcium, albumin, and vitamin D-binding protein were measured. Self-designed questionnaires were collected. The bioavailable 25-(OH)D levels were calculated. A multivariate logistic regression model was used to analyze the association between bioavailable 25-(OH)D and parathyroid hormone levels and functional outcome in the elderly with fragile hip fractures. Receiver Operating Characteristic (ROC) was used to investigate the predictive value of bioavailable 25-(OH) D and parathyroid hormone levels, and postoperative function in the elderly with fragile hip fractures. Results A total of 318 patients were enrolled in this study. Total 25-(OH)D level (OR = 0.866,95% CI: 0.834-0.899, P < 0.001), bioavailable 25-(OH)D level (OR = 0.775,95% CI: 0.655-0.917, P = 0.003), and parathyroid hormone level (OR = 1.909,95% CI: 0.852-0.969, P = 0.004) were associated with rehabilitation outcomes. ROC curve analysis showed that the areas under the curve of total 25-(OH)D, bioavailable 25-(OH)D, and parathyroid hormone were 0.826, 0.644 and 0.579, respectively. Conclusion High total 25-(OH)D level, high bio-available 25-(OH) D level, and low parathyroid hormone level promote functional recovery after hip fracture surgery in the elderly.
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