2022 年第 6 期 第 17 卷

血液透析对髋部脆性骨折患者术后生存的影响及危险因素分析

Influence of hemodialysis on survivorship and analysis of survival associated risk factors in patients after fragility-related hip fracture surgery

作者：杨洁1康建国2王晓飞1张利平1左力3

英文作者：Yang Jie1 Kang Jianguo2 Wang Xiaofei1， Zhang Liping1 Zuo Li3

单位：1北京积水潭医院肾内科，北京100096；2首都医科大学教学医院国家电网北京电力医院骨科，北京100073；3北京大学人民医院肾内科，北京100044

英文单位：1Department of Nephrology Beijing Jishuitan Hospital Beijing 100035 China; 2Department of Orthopaedics Beijing Electric Power Hospital Teaching Hospital of Capital Medical University Beijing 100073 China; 3Department of Nephrology Peking University People′s Hospital Beijing 100044 China

关键词：血液透析；髋部骨折；生存时间

英文关键词：Hemodialysis；Hipfracture；Survivaltime

• 摘要：

• 目的 研究血液透析对髋部脆性骨折患者术后生存的影响，分析影响患者术后生存的危险因素。方法 选取2011年10月至2019年5月于北京积水潭医院住院的23例接受血液透析的髋部脆性骨折患者（透析组）进行回顾性分析。根据年龄、性别、骨折部位、手术方式进行1∶3匹配队列，抽取同期住院、肾功能正常髋部脆性骨折手术患者69例作为对照组。记录患者从手术到死亡的时间，所有患者均随访至2021年12月31日终止。通过Kaplan-Meier生存曲线及Log-rank检验分析患者生存率。分析影响髋部脆性骨折患者术后生存的危险因素。结果 透析组年龄校正Charlson合并症指数（aCCI），术前血尿素氮、血肌酐、血磷水平均高于对照组，总住院天数长于对照组，术前血红蛋白、血细胞比容（HCT）白蛋白及术后最低血红蛋白、HCT水平均低于对照组，差异均有统计学意义（均P＜0.05）。随访期间，透析组死亡17例（73.9%），对照组死亡26例（37.7%），2组比较差异有统计学意义（P＜0.05）。透析组患者术后中位生存时间为4.31年，对照组为6.86年。Kaplan-Meier生存曲线分析结果显示，透析组患者累积生存率明显低于对照组（Log-rank P=0.002）。多因素Cox回归分析结果显示，血液透析（风险比=3.260,95%置信区间：1.703~6.242）、年龄≥80岁（风险比=2.496,95%置信区间：1.247~4.995）、骨折部位/手术方式（风险比=0.438,95%置信区间：0.229~0.836）、术前白蛋白水平低（风险比=0.928,95%置信区间：0.871~0.988）均为影响髋关节脆性骨折患者术后生存的独立危险因素（均P＜0.05）。结论 与肾功能正常的髋部脆性骨折患者比较，血液透析合并髋部脆性骨折的患者术后生存状况较差，全因死亡率明显增高。血液透析、年龄≥80岁、骨折部位/手术方式、术前白蛋白水平低是影响髋部脆性骨折患者术后生存的独立危险因素。

• Objective To investigate the influence of hemodialysis on survivorship in patients after fragility-related hip fracture surgery, and to analyze survival associated risk factors. Methods Totally 23 hemodialysis patients (dialysis group) who underwent surgical treatment for fragility-related hip fracture in Beijing Jishuitan Hospital from October 2011 to May 2019 were selected retrospectively. According to 1∶3 matched cohort based on age, gender，fracture type and surgery approach, 69 patients with normal renal function who had sustained a hip fracture during the same year were selected as the control group. Survival status of patients was followed-up until death or the end of December 31, 2021. Survival rate was analyzed by Kaplan-Meier survival curve and Log-rank test. The risk factors for survival in patients after fragility-related hip fracture surgery were analyzed. Results   The age-adjusted Charlson Comorbidity Index (aCCI), preoperative levels of blood urea nitrogen, blood creatinine and blood phosphorus in the dialysis group were higher than those in the control group; total length of stay in the dialysis group was longer than that in the control group; preoperative levels of hemoglobin, hematocrit, albumin and postoperative lowest levels of hemoglobin and hematocrit in the dialysis group were lower than those in the control group (all P<0.05). During the follow-up, 17 cases (73.9%) died in the dialysis group, 26 cases (37.7%) died in the control group, and the difference was statistically significant (P<0.05). Median postoperative survival time was 4.31 years in the dialysis group and was 6.86 years in the control group. Kaplan-Meier survival curve analysis showed that cumulative survival rate in the dialysis group was lower than that in the control group (Log-rank P=0.002). Multivariate Cox regression analysis showed that hemodialysis（hazard ratio=3.260, 95% confidence interval： 1.703-6.242）, age≥80 years（hazard ratio=2.496, 95% confidence interval： 1.247-4.995）, fracture type/surgery approach （hazard ratio=0.438, 95% confidence interval： 0.229-0.836） and low preoperative level of albumin （hazard ratio=0.928, 95% confidence interval： 0.871-0.988）  were independent risk factors for survivorship in patients after fragility-related hip fracture surgery (all P<0.05). Conclusions  Survival of hemodialysis patients after fragility-related hip fracture surgery was worse than that of patients with normal renal function and the overall mortality were higher. Hemodialysis, age≥80 years, fracture type/surgery approach and low preoperative level of albumin were independent risk factors for survivorship in patients after fragility-related hip fracture surgery.