文献类型：期刊文献

中文题名：预后营养指数对老年骨质疏松症患者髋关节置换术后风险预测及影响因素分析

英文题名：The analysis of the risk prediction and the influential factors of hip arthroplasty in the elderly patients with osteoporosis

作者：郭小荣[1];郭成龙[1];崔巧梅[1];魏煊[1];张虎林[1]

第一作者：郭小荣

机构：[1]甘肃中医药大学附属医院,甘肃兰州730020

第一机构：甘肃中医药大学第二附属医院

年份：2020

卷号：26

期号：7

起止页码：967

中文期刊名：中国骨质疏松杂志

外文期刊名：Chinese Journal of Osteoporosis

收录：CSTPCD;;北大核心:【北大核心2017】；CSCD:【CSCD2019_2020】；

基金：国家自然科学基金(81360554);兰州市科技计划项目(2018-3-43)。

语种：中文

中文关键词：预后营养指数;骨质疏松;髋关节置换术;风险预测;体质量指数

外文关键词：prognostic nutritional index;osteoporosis;hip replacement;outcome status;body mass index

摘要：目的分析预后营养指数(prognostic nutritional index,PNI)与老年骨质疏松(osteoporosis,OP)症患者髋关节置换术后的风险预测及影响因素,探讨PNI作为老年骨质疏松症患者髋关节置换术后风险及预后指标的作用价值。方法回顾性分析本院2016年5月至2018年12月收治的老年OP行髋关节置换术264例患者的临床资料,根据PNI指数分为PNI≥45(112例)和PNI<45(152例),通过单因素和多因素分析评价老年骨质疏松症患者髋关节置换术后影响因素,并分析其预测价值。结果 PNI<45的分组患者比PNI≥45分组患者具有更高的年龄、体质量指数(body mass index,BMI)、高术后并发症、低骨密度、高血清PTH及BLAP含量、低Harris评分,差异具有统计学意义(P均<0.05)。但其他指数和指标在两组间对比,差异无统计学意义(P均>0.05)。不同PNI分组患者的营养免疫相关血液学指标(HGB、TP、ALB、LYMPH、RBC、PALB)及BMI、Harris评分情况在不同时间段进行纵向变化比较,组内及组间差异分别具有统计学意义(P<0.05,P<0.01)。多因素分析结果显示,PNI(HR=1.26,95%CI:0.89~2.01,P<0.001,标准化偏回归系数=0.055)的贡献度最高,是预测术后的独立危险因素。且Kappa系数提示,PNI与Harris筛查评定结果具有一致性(P<0.001)。结论 PNI是老年骨质疏松症患者髋关节置换术后独立影响因素,对老年骨质疏松症患者髋关节置换术后风险预测及影响因素分析具有重要意义。
Objective To analyze the risk prediction and the influencing factors with prognostic nutritional index(PNI)after hip replacement in elderly patients with osteoporosis,and to discuss the effect of PNI on the outcome of hip replacement in elderly patients with osteoporosis.Methods The clinical data of 264 elderly patients with OP undergone hip arthroplasty from May 2016 to December 2018 were analyzed retrospectively.According to PNI index,there were 112 patients with PNI≥45 and 152 patients with PNI<45.Single factor and multivariate analysis were used to evaluate the current status and influencing factors of the outcome after hip arthroplasty in elderly patients with osteoporosis,and to analyze its predictive value.Results The general data showed that the patients in PNI≥45 group had higher age,BMI,postoperative complications,serum PTH and BLAP content,and lower bone mineral density and low Harris score than those in PNI≥45 group,and the difference was statistically significant(P<0.05).However,there were no significant differences in other indexes between the two groups(P>0.05).The nutritional and immune related hematological indexes(HGB,TP,ALB,LYMPH,RBC,and PALB)and BMI,Harris scores of patients with different PNI groups were compared longitudinally in different time periods.There were significant differences within and between groups(P<0.05,P<0.01).The result of multivariate analysis showed that PNI(HR=1.26,95%CI:0.89-2.01,P<0.001,standardized partial regression coefficient=0.055)had the highest contribution,and was an independent risk factor for predicting prognosis.Moreover,Kappa coefficient indicated that PNI was consistent with Harris screening evaluation result(P<0.001).Conclusion PNI is an independent influential factor in the elderly patients with osteoporosis after hip replacement.It is of great significance to predict the outcome of hip replacement in the elderly patients with osteoporosis and to analyze the influencing factors.