2021 年第 5 期 第 16 卷

低三碘甲状腺原氨酸综合征对老年髋部骨折患者术后30天预后的影响

Effect of low triiodothyronine syndrome on prognosis 30 days after operation in elderly patients with hip fracture

作者：蔡濛汪蕾

英文作者：Cai Meng Wang Lei

单位：北京积水潭医院老年科100035

英文单位：Department of Geriatrics Beijing Jishuitan Hospital Beijing 100035 China

关键词：低三碘甲状腺原氨酸综合征；髋部骨折；老年人；死亡率

英文关键词：Lowtriiodothyroninesyndrome;Hipfracture;Elderly;Mortality

• 摘要：

• 目的 探讨低三碘甲状腺原氨酸（T3）综合征对老年髋部骨折患者术后30 d预后的影响。方法 回顾性分析北京积水潭医院2018年10月至2019年2月收治的248例老年髋部骨折患者的临床资料和随访资料。根据患者入院时血清T3水平分为低T3组（137例）和非低T3组（111例），根据患者术后30 d预后情况分为死亡组（7例）和存活组（241例）。比较T3有无减低组和术后30 d不同预后组患者性别、年龄、骨折前基础疾病、体重指数、骨折类型、诺丁汉髋部骨折评分（NHFS）、左心室射血分数（LVEF），血清白蛋白、T3、甲状腺素、促甲状腺激素（TSH）水平和肾小球滤过率（GFR）的差异，分析患者术后30 d全因死亡的影响因素。结果 低T3组年龄，骨折前合并高血压、痴呆比例，NHFS，股骨粗隆间骨折、术后30 d死亡比例均高于非低T3组，血清白蛋白、甲状腺素、GFR水平均低于非低T3组（均P＜0.05）。死亡组骨折前合并帕金森病比例和NHFS均高于存活组［14.3%（1/7）比2.1%（5/241），6(5,7)分比5（4,6）分］，血清T3和GFR水平均低于存活组［0.7(0.6，1.0)nmol/L比1.1（0.9，1.3）nmol/L，43（6，56）ml/min比62(45，79)ml/min］（均P＜0.05）。Logistic回归分析结果 表明血清T3水平升高为老年髋部骨折患者术后30 d死亡的保护因素（比值比=0.003，95%置信区间：0~0.402，P=0.020）。结论 血清T3水平升高为老年髋部骨折患者术后30 d全因死亡的保护因素。

• Objective To investigate the effect of low triiodothyronine (T3) syndrome on the prognosis 30 d after operation of elderly patients with hip fracture. Methods The clinical data and follow-up data of 248 elderly patients with hip fracture in Beijing Jishuitan Hospital from October 2018 to February 2019 were retrospectively analyzed. The patients were divided into low T3 group (137 cases) and non low T3 group (111 cases) according to the serum T3 level at admission. The patients were divided into death group (7 cases) and survival group (241 cases) according to the prognosis 30 d after operation. The differences of gender, age, basic disease before fracture, body mass index, fracture type, Nottingham hip fracture score(NHFS), left ventricular ejection fraction(LVEF), serum albumin, T3, tetraiodothyronine(T4), thyroid stimulating hormone(TSH) levels and glomerular filtration rate(GFR) in different T3 levels groups and different prognosis 30 d after operation groups were compared. The influencing factors of all-cause death 30 d after operation were analyzed. Results The age, proportions of hypertension and dementia before fracture, NHFS, intertrochanteric fracture and the mortality 30 d after operation in the low T3 group were higher than those in the non low T3 group, and the levels of serum albumin, T4 and GFR were lower than those in the non low T3 group (all P<0.05). The proportion of Parkinson′s disease before fracture and NHFS in the death group were higher than those in the survival group ［14.3%(1/7) vs 2.1%(5/241), 6(5,7) vs 5(4,6)］, and the serum T3 and GFR levels in the death group were lower than those in the survival group ［0.7(0.6,1.0)nmol/L vs 1.1(0.9,1.3)nmol/L, 43(6,56)ml/min vs 62(45,79)ml/min］ (all P<0.05). Logistic regression analysis showed that serum T3 level elevating was a protective factor for mortality 30 d after operation in elderly patients with hip fracture (odds ratio=0.003, 95% confidence interval: 0-0.402, P=0.020). Conclusion Serum T3 is a protective factor for all cause death in elderly patients with hip fracture 30 d after operation.