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[1]陳敏,余澤蕓,宋丹,等.老年膝骨關(guān)節(jié)炎合并肌少癥的影響因素分析及風(fēng)險預(yù)測模型構(gòu)建[J].中醫(yī)正骨,2025,37(03):23-28,38.
　CHEN Min,YU Zeyun,SONG Dan,et al.Influencing factors and a risk forecasting model for knee osteoarthritis complicated with sarcopenia in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(03):23-28,38.
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老年膝骨關(guān)節(jié)炎合并肌少癥的影響因素分析及風(fēng)險預(yù)測模型構(gòu)建()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第37卷
期數(shù):
2025年03期
頁碼:
23-28,38
欄目:
臨床研究
出版日期:
2025-03-20

文章信息/Info

Title:
Influencing factors and a risk forecasting model for knee osteoarthritis complicated with sarcopenia in the aged
作者:
陳敏; 余澤蕓; 宋丹; 周禮; 熊小琴
宜賓市第一人民醫(yī)院,四川 宜賓 644000
Author(s):
CHEN Min; YU Zeyun; SONG Dan; ZHOU Li; XIONG Xiaoqin
The First People's Hospital of Yibin,Yibin 644000,Sichuan,China
關(guān)鍵詞:
骨關(guān)節(jié)炎; 膝;  肌肉衰減征;  老年人;  Logistic模型;  因素分析; 統(tǒng)計學(xué);  列線圖表;  風(fēng)險;  預(yù)測
Keywords:
osteoarthritis; knee;  sarcopenia;  aged;  logistic models;  factor analysis; statistical;  nomograms;  risk;  forecasting
摘要:
目的:探討老年膝骨關(guān)節(jié)炎(knee osteoarthritis,KOA)合并肌少癥的影響因素,并構(gòu)建老年KOA合并肌少癥的風(fēng)險預(yù)測模型。方法:選取2020年6月至2024年12月在宜賓市第一人民醫(yī)院住院治療的KOA患者為研究對象。將2020年6月至2024年6月納入的患者歸入模型組(用于模型建立),將2024年7—12月納入的患者歸入為驗證組(用于模型驗證)。采用亞洲肌少癥工作組制定的肌少癥診斷方法診斷肌少癥,收集患者性別、年齡、體質(zhì)量指數(shù)、KOA病程、Kellgren-Lawrence分級、蛋白質(zhì)攝入量、膝關(guān)節(jié)疼痛視覺模擬量表(visual analogue scale,VAS)評分、西安大略和麥克馬斯特大學(xué)骨關(guān)節(jié)炎指數(shù)(Western Ontario and McMaster Universities osteoarthritis index,WOMAC)分級、吸煙、酗酒、規(guī)范治療、規(guī)律運動、合并基礎(chǔ)疾病、鈣劑補充、維生素D補充等信息。將模型組患者根據(jù)是否合并肌少癥,分為合并肌少癥組和不合并肌少癥組。先對合并肌少癥組和不合并肌少癥組患者的相關(guān)信息進行單因素對比分析,對其中組間差異有統(tǒng)計學(xué)意義的因素進行Lasso回歸分析,將Lasso回歸分析篩選出來的因素用于多因素Logistic回歸分析。采用R語言和rms程序包構(gòu)建老年KOA合并肌少癥的列線圖預(yù)測模型。分別基于模型組和驗證組數(shù)據(jù),采用受試者操作特征(receiver operating characteristic,ROC)曲線和Hosmer-Lemeshow擬合優(yōu)度檢驗分別評價老年KOA合并肌少癥列線圖預(yù)測模型的區(qū)分度和校準度。結(jié)果:共納入模型組患者675例,其中合并肌少癥組196例,不合并肌少癥組479例; 納入驗證組患者77例。合并肌少癥組和不合并肌少癥組患者年齡、KOA病程、Kellgren-Lawrence分級、蛋白質(zhì)攝入量、膝關(guān)節(jié)疼痛VAS評分、WOMAC分級、酗酒、規(guī)范治療、規(guī)律運動、合并基礎(chǔ)疾病、維生素D補充情況比較,組間差異均有統(tǒng)計學(xué)意義[(73.8±5.2)歲,(68.3±4.6)歲,t=12.921,P=0.000;(26.5±3.9)個月,(19.6±4.6)個月,t=19.768,P=0.000; χ2=16.171,P=0.000;(59.3±6.5)g·d-1,(63.9±6.3)g·d-1,t=8.475,P=0.000;(5.6±1.7)分,(4.7±1.3)分,t=7.109,P=0.000; χ2=8.627,P=0.013; χ2=8.082,P=0.004; χ2=4.076,P=0.043; χ2=10.096,P=0.001; χ2=10.822,P=0.004; χ2=7.644,P=0.006]。Lasso回歸分析篩選出年齡、KOA病程、Kellgren-Lawrence分級、蛋白質(zhì)攝入量、膝關(guān)節(jié)疼痛VAS評分、規(guī)律運動和 WOMAC 分級為老年KOA合并肌少癥的預(yù)測變量。Logistic回歸分析結(jié)果顯示,年齡、KOA病程和膝關(guān)節(jié)疼痛VAS評分是老年KOA合并肌少癥的危險因素,蛋白質(zhì)攝入量是老年KOA合并肌少癥的保護因素。采用模型組數(shù)據(jù)進行老年KOA合并肌少癥列線圖預(yù)測模型驗證,ROC曲線下面積為0.865[P=0.000,95%CI(0.837,0.892)],采用驗證組數(shù)據(jù)進行老年KOA合并肌少癥列線圖預(yù)測模型驗證,ROC曲線下面積為0.762[P=0.000,95%CI(0.709,0.811)]; Hosmer-Lemeshow擬合優(yōu)度檢驗結(jié)果顯示,模型組最大、最小偏移量分別為0.037、0.011(P=0.885),驗證組最大、最小偏移量分別為0.058、0.031(P=0.773)。結(jié)論:年齡、KOA病程和膝關(guān)節(jié)疼痛VAS評分是老年KOA合并肌少癥的危險因素,蛋白質(zhì)攝入量是老年KOA合并肌少癥的保護因素,基于上述因素構(gòu)建的老年KOA合并肌少癥列線圖預(yù)測模型具有較高的應(yīng)用價值。
Abstract:
Objective:To explore the influencing factors of knee osteoarthritis complicated with sarcopenia in the aged,and to construct a risk prediction model for KOA complicated with sarcopenia in the aged.Methods:The KOA patients hospitalized at The First People's Hospital of Yibin from June 2020 to December 2024 were selected as the subjects.The ones admitted from June 2020 to June 2024 were assigned into the model group(for model building),while those from July 2024 to December 2024 into the validation group(for model validation).The information of the patients,including gender,age,body mass index(BMI),KOA duration,Kellgren-Lawrence(K-L)grade,protein intake,knee pain visual analogue scale(VAS)score,Western Ontario and McMaster Universities osteoarthritis index(WOMAC)grade,smoking,alcohol abuse,standardized treatment,regular exercise,combined with underlying diseases,calcium supplementation,and vitamin D supplementation,was collected,and the sarcopenia was diagnosed among the included KOA patients using the diagnostic methods developed by the Asian Working Group for Sarcopenia(AWGS).According to the results,the KOA patients with and without sarcopenia in model group were subgrouped into a sarcopenia group and a non-sarcopenia group.After that,a single-factor analysis was conducted on the extracted information of patients in the 2 subgroups,followed by a Lasso regression analysis on the factors with statistically significant differences between the 2 subgroups,based on which a multi-factor logistic regression analysis on the factors screened by Lasso regression analysis was performed.According to the findings,a nomogram prediction model for KOA complicated with sarcopenia in the aged was constructed using the R language and rms package,and the discrimination and calibration performance of the nomogram prediction model were analyzed and evaluated by using the receiver operating characteristic(ROC)curve and Hosmer-Lemeshow goodness-of-fit(GOF)test based on the data of model group and validation group,respectively.Results:Seventy-seven patients were enrolled in the validation group,and 675 ones in model group,among which 196 ones in sarcopenia group,and 479 ones in non-sarcopenia group.The single-factor analysis showed significant differences between sarcopenia group and non-sarcopenia group in the age,KOA duration,K-L grade,protein intake,knee pain VAS score,WOMAC grade,alcohol abuse,standardized treatment,regular exercise,combined with underlying diseases,and vitamin D supplementation(73.8±5.2 vs 68.3±4.6 years,t=12.921,P=0.000; 26.5±3.9 vs 19.6±4.6 months,t=19.768,P=0.000; χ2=16.171,P=0.000; 59.3±6.5 vs 63.9±6.3 g/day,t=8.475,P=0.000; 5.6±1.7 vs 4.7±1.3 points,t=7.109,P=0.000; χ2=8.627,P=0.013; χ2=8.082,P=0.004; χ2=4.076,P=0.043; χ2=10.096,P=0.001; χ2=10.822,P=0.004; χ2=7.644,P=0.006).After Lasso regression analysis,age,KOA duration,K-L grade,protein intake,knee pain VAS score,regular exercise,and WOMAC grade were identified as the variables for predicting sarcopenia in the aged KOA patients.The multi-factor logistic regression analysis showed that the age,KOA duration,and knee pain VAS score were the risk factors,while the protein intake was a protective factor for KOA complicated with sarcopenia in the aged.The area under the ROC curve of the nomogram prediction model for KOA complicated with sarcopenia in the aged validated based on the data of model group and validation group was 0.865(P=0.000,95%CI(0.837,0.892))and 0.762(P=0.000,95%CI(0.709,0.811)),respectively.The Hosmer-Lemeshow GOF test showed that the maximum and minimum offsets was 0.037 and 0.011(P=0.885),respectively,in model group,and 0.058 and 0.031(P=0.773),respectively,in validation group.Conclusion:Age,KOA duration,and knee pain VAS score are the risk factors for KOA complicated with sarcopenia,while the protein intake is a protective factor against sarcopenia in the aged KOA patients.The nomogram prediction model constructed based on the above factors has a high clinical applied value in predicting the risk for sarcopenia in the aged KOA patients.

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備注/Memo

備注/Memo:
基金項目:四川省衛(wèi)生和健康委員會科研課題(21PJ011)
通訊作者:陳敏 E-mail:[email protected]
更新日期/Last Update: 1900-01-01