脂肪细胞因子作为髋部骨折患者一年死亡率的预后因素的作用。
The role of adipokines as prognostic factors of one-year mortality in hip fracture patients.
机构信息
Department of Nephrology and Dialysis, University Hospital Center "Sestre Milosrdnice", University of Zagreb Medical School, 10000, Zagreb, Croatia.
Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital Center "Sestre Milosrdnice", University of Zagreb Medical School, 10000, Zagreb, Croatia.
出版信息
Osteoporos Int. 2017 Aug;28(8):2475-2483. doi: 10.1007/s00198-017-4068-2. Epub 2017 May 13.
UNLABELLED
This study investigated the impact of anthropometric parameters, adiponectin, leptin, homeostatic model assessment for insulin resistance (HOMA-IR), beta-isomerised C-terminal telopeptide of collagen type I (β-CTX), and routine biochemical tests on one-year mortality in hip fracture patients. We found that male patients with high adiponectin, leptin, and β-CTX levels had a 5-fold increase in all-cause one-year mortality.
INTRODUCTION
Several predictors of one-year hip fracture mortality have been identified including advanced age, male sex, low bone mineral density, and preexisting comorbidities. However, the impact of metabolic parameters on hip fracture mortality remains unknown. The aim of this study was to examine the effect of serum leptin and adiponectin levels, as well as other metabolic parameters on all-cause one-year hip fracture mortality.
METHODS
This prospective study included 236 patients of all ages with non-traumatic hip fractures. Anthropometric parameters, adiponectin, leptin, HOMA-IR, β-CTX, and routine biochemical tests were recorded at admission and correlated with one-year mortality by using multivariate Cox proportional hazard models.
RESULTS
The median patient age was 82 (75-87) years, and one-year mortality rate was 28.4%. In univariate analysis, adiponectin, age, β-CTX, and renal function were associated with mortality. However, in a multivariate model, male gender, high β-CTX, adiponectin, and leptin were independently associated with increased mortality. Thus, we constructed a nomogram that included all the latter variables in addition to age. The nomogram predicted mortality with a sensitivity of 74.8% (66.0-82.3) and specificity of 74.4% (57.9-87.0), and had an area under the curve of 0.784. Patients that scored <9.2 had a mortality of 10.1%, while those with >9.2 had a mortality of 49.2% (relative risk 5.4, 95% CI 2.8-10.2, P < 0.001).
CONCLUSION
Male patients with high adiponectin, leptin, and β-CTX levels have a 5-fold increase in all-cause one-year mortality after hip fracture.
目的
本研究旨在探讨人体测量参数、脂联素、瘦素、胰岛素抵抗评估的稳态模型（HOMA-IR）、I 型胶原 C 端β-异构体肽（β-CTX）以及常规生化检测对髋部骨折患者一年死亡率的影响。我们发现，男性患者中，脂联素、瘦素和β-CTX 水平较高者，其全因一年死亡率增加了 5 倍。
简介
已确定了一些与髋部骨折一年死亡率相关的预测因素，包括年龄较大、男性、低骨密度和预先存在的合并症。然而，代谢参数对髋部骨折死亡率的影响仍不清楚。本研究的目的是检查血清瘦素和脂联素水平以及其他代谢参数对全因一年髋部骨折死亡率的影响。
方法
这项前瞻性研究纳入了 236 名年龄在任何年龄段的非创伤性髋部骨折患者。在入院时记录了人体测量参数、脂联素、瘦素、HOMA-IR、β-CTX 和常规生化检测结果，并通过多变量 Cox 比例风险模型将其与一年死亡率相关联。
结果
患者的中位年龄为 82（75-87）岁，一年死亡率为 28.4%。在单因素分析中，脂联素、年龄、β-CTX 和肾功能与死亡率相关。然而，在多变量模型中，男性、高β-CTX、脂联素和瘦素与死亡率增加独立相关。因此，我们构建了一个包含所有上述变量的列线图，此外还包含年龄。该列线图预测死亡率的敏感度为 74.8%（66.0-82.3），特异性为 74.4%（57.9-87.0），曲线下面积为 0.784。评分<9.2 的患者死亡率为 10.1%，而评分>9.2 的患者死亡率为 49.2%（相对风险 5.4，95%CI 2.8-10.2，P<0.001）。
结论
髋部骨折后，男性患者脂联素、瘦素和β-CTX 水平较高者，其全因一年死亡率增加了 5 倍。
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