老年重症患者骨质流失相关危险因素分析

目的探讨老年重症患者骨质流失的相关危险因素。 方法纳入2020年7月至2021年7月浙江大学医学院附属金华医院收治的老年重症患者，测量其入住ICU前后的骨密度数据，T值下降>10%为存在骨质流失。先采用t检验、秩和检验、χ²检验比较骨质流失组与对照组临床资料的差异，再通过多因素logistic回归分析骨质流失的相关危险因素。 结果共纳入老年重症患者71例，骨质流失组41例，对照组30例。与对照组比较，骨质流失组入院时氧合指数较低、序贯器官衰竭评估评分较高、接受连续性肾脏替代治疗患者的比例较高、机械通气时间及制动时间均较长（t=-3.516，χ²=8.019，Z=-3.990、-3.161、-2.056，P<0.05或0.01）。两组患者入ICU时实验室检查指标中仅白细胞计数、C反应蛋白、白介素-6的差异有统计学意义（t=2.682，Z=-3.108、3.307，P<0.01）。多因素分析结果显示，引起患者骨质流失的相关危险因素包括入ICU时SOFA评分高、白介素-6水平高，住ICU期间行CRRT以及机械通气时间长（OR=1.223、1.080、6.635、1.004，P<0.05）。 结论老年重症患者住ICU期间发生骨质流失的风险较高，引起骨质流失相关的危险因素包括入ICU时SOFA评分高、白介素-6水平高，住ICU期间进行CRRT以及机械通气时间长。

Risk factors of bone loss in elderly patients with critical illness

ObjectiveTo identify the risk factors of bone loss in elderly patients with critical illness. MethodsElderly patients with critical illness admitted to Affiliated Jinhua Hospital, Zhejiang University School of Medicine during July 2020 and July 2021 were enrolled in the study. Quantitative ultrasonography was used to assess the bone mass. Those T value decreases by more than 10% were defined as bone loss. The differences of clinical data between bone loss group and control group were observed by T test, rank sum test, χ² test, and the related risk factors of bone loss were determined by multivariate logistic regression analysis. ResultsA total of 71 elderly patients with critical illness were enrolled in the study, in which 41 patiens were in bone loss group and 30 patients in control group. When compared with control group, patients in bone loss group were more likely to have lower FiO₂, higher sequential organ failure assessment (SOFA) score on ICU admission and more continuous renal replacement therapy (CRRT) treatment, longer mechanical ventilation time, longer braking time (t=-3.516, χ²=8.019, Z=-3.990, -3.161, -2.056, P < 0.05 or < 0.01). Only white blood cell count, C-reactive protein and interleukin-6 on ICU admission showed statistically significant differences between the two groups (t=2.682, Z=-3.108, 3.307, P < 0.01). Multivariate analysis showed that risk factors with bone loss were high SOFA score, high interleukin-6 levels on ICU admission, CRRT treatment and long mechanical ventilation time during ICU stay (OR=1.223, 1.080, 6.635, 1.004, P < 0.05). ConclusionElderly patients with critical illness in ICU have high risk of bone loss. Patients with high SOFA score and IL-6 level on admission, CRRT treatment and long mechanical ventilation time during ICU are more likely to have bone loss.