【罂粟摘要】维生素D缺乏与髋部骨折手术后活动能力降低有关：一项前瞻性研究

维生素D缺乏与髋部骨折手术后活动能力降低有关：一项前瞻性研究

背景

髋部骨折具有较高的发病率和死亡率，手术后成功离床活动是这类患者的重要预后。

目的

本研究旨在确定25-羟基维生素D[25(OH)D]浓度或老年营养风险指数(GNRI)是否与髋部骨折术后患者队列中的死亡率或步行速度有关。

方法

研究对象为北美一项多点研究中的接受髋部骨折修复术的患者。分别于术后30d和60d评估死亡率和活动度。测定血清白蛋白、25(OH)D和全段甲状旁腺激素。根据5(OH)D<12 ng/mL、12~<20 ng/mL、20~<30 ng/mL或≥30 ng/mL对患者进行分类。GNRI分为严重/中度营养危险(<92)、部分危险(92~<98)、或营养状况良好(≥98)。结果：290例患者中，73%为女性[年龄82±10.7岁，体重指数(kg/m²)：25±5]。与25(OH)D浓度<12 ng/mL的患者相比，25(OH)D浓度较高的患者30d步行速率较高(P=0.031)：12~<20 ng/mL(校正OR：2.61；95%CI：1.13，5.99)；20~<30 ng/mL(3.48；1.53，7.95)；≥30 ng/mL(2.84；1.12，7.20)。此外，与对照组(<12 ng/mL)相比，25(OH)D升高的患者在60d时也有更大的流动性(P=0.028)。营养不良(GnRI<92)在30d时总体表现为活动能力下降(未调整P值=0.044，调整后P值=0.056)，而在60d时无明显变化，维生素D或GNRI与死亡率均无相关性。

结论

维生素D缺乏(<12 ng/mL)与髋部骨折手术后活动减少有关，而GNRI也导致活动不能，但不是一个可靠的预测指标。解释维生素D缺乏与行动不便因何相关的机制应该在未来的研究中解决。

Vitamin D deficiency is associated with reduced mobility after hip fracture surgery: a prospective study

ABSTRACT 

Background: Hip fractures are associated with a high rate of morbidity and mortality, and successful ambulation after surgery is an important outcome in this patient population. 

Objective: This study aims to determine whether 25-hydroxyvitamin D [25(OH)D] concentration or the Geriatric Nutritional Risk Index (GNRI) is associated with mortality or rates of walking in a patient cohort after hip fracture surgery. 

Methods: Patients undergoing hip fracture repair from a multisite study in North America were included. Mortality and mobility were assessed at 30 and 60 d after surgery. Serum albumin, 25(OH)D, and intact parathyroid hormone were measured. Patients were characterized according to 25(OH)D <12 ng/mL, 12 to <20 ng/mL, 20 to <30 ng/mL, or ≥30 ng/mL. GNRI was categorized into major/moderate nutritional risk (<92), some risk (92 to <98), or in good nutritional status (≥98). 

Results: Of the 290 patients [aged 82 ± 7 y, BMI (kg/m²): 25 ± 5], 73% were women. Compared with patients with <12 ng/mL, those with higher 25(OH)D concentrations had higher rates of walking at 30 d (P = 0.031): 12 to <20 ng/mL (adjusted OR: 2.61; 95% CI: 1.13, 5.99); 20 to <30 ng/mL (3.48; 1.53, 7.95); ≥30 ng/mL (2.84; 1.12, 7.20). In addition, there was also greater mobility at 60 d (P = 0.028) in patients with higher 25(OH)D compared with the reference group (<12 ng/mL). Poor nutritional status (GNRI <92) showed an overall trend to reduce mobility (unadjusted P = 0.044 and adjusted P = 0.056) at 30 but not at 60 d. There was no association of vitamin D or GNRI with mortality at either time. 

Conclusions: Vitamin D deficiency (<12 ng/mL) is associated with reduced ambulation after hip fracture surgery, whereas GNRI also contributes to immobility but is a less reliable predictor. Mechanisms that can explain why vitamin D deficiency is associated with mobility should be addressed in future studies.

翻译：周菁    编辑：佟睿    审校：曹莹

贵州医科大学高鸿教授课题组