预后营养指数对老年女性OVCF病人PVA术后再发椎体骨折的影响

doi:10.3969/j.issn.1003-9198.2023.05.009

实用老年医学 ›› 2023, Vol. 37 ›› Issue (5): 470-474.doi: 10.3969/j.issn.1003-9198.2023.05.009

预后营养指数对老年女性OVCF病人PVA术后再发椎体骨折的影响

徐凤周, 高开茜, 孙亮亮, 高学峰, 张雄, 刘永强, 周建伟

050011 河北省石家庄市,石家庄市人民医院骨科(徐凤周,孙亮亮,高学峰,张雄,刘永强,周建伟);
050021 河北省石家庄市,石家庄市第五医院内科(高开茜)

收稿日期:2022-07-05 出版日期:2023-05-20 发布日期:2023-05-23
通讯作者: 高开茜,Email: 148066624@qq.com
基金资助:
石家庄市科技支撑计划(211200823)

Effect of prognostic nutritional index on recurrent vertebral fractures after percutaneous vertebral augmentation in elderly female patients with osteoporotic vertebral compression fractures

XU Feng-zhou, GAO Kai-qian, SUN Liang-liang, GAO Xue-feng, ZHANG Xiong, LIU Yong-qiang, ZHOU Jian-wei

Department of Orthopedics, Shijiazhuang People's Hospital, Shijiazhuang 050011, China(XU Feng-zhou,SUN Liang-liang, GAO Xue-feng, ZHANG Xiong, LIU Yong-qiang, ZHOU Jian-wei);
Department of General Internal Medicine, Shijiazhuang Fifth Hospital, Shijiazhuang 050021, China(GAO Kai-qian)

Received:2022-07-05 Online:2023-05-20 Published:2023-05-23
Contact: GAO Kai-qian, Email: 148066624@qq.com

摘要/Abstract

摘要： 目的调查老年女性骨质疏松性椎体压缩骨折(OVCF)病人行椎体强化术(PVA)后再发椎体骨折的情况及影响因素。方法回顾性调查205例接受PVA术的老年女性OVCF病人,收集其年龄、BMI、入院血常规、血生化指标及骨密度(BMD)等基本情况,调查时间为PVA术后2～40个月,根据是否出现椎体再骨折分为再骨折组及对照组。采用单因素及多因素Cox回归分析老年女性OVCF病人PVA术后再发椎体骨折的影响因素,采用Logistic回归计算独立影响因素的概率,绘制ROC曲线。结果老年女性OVCF病人PVA术后再发椎体骨折发生率为20.5 %。Cox回归分析显示,预后营养指数(PNI)、BMD、年龄、是否服用抗骨质疏松(OP)药物是PVA术后再发椎体骨折的独立影响因素;与低PNI病人相比,高PNI病人PVA术后再发骨折风险更低;PNI与是否服用抗OP药物存在交互作用,在高PNI组抗OP药物疗效更好,P_interaction＜0.05。ROC曲线结果显示,相较于无PNI因素模型,含有PNI因素的模型ROC曲线面积增加了0.066(0.003～0.127)。结论高PNI是老年女性OVCF病人PVA术后再发椎体骨折的保护因素,对PVA术后椎体再骨折有预测价值,可以通过提高抗OP药物的疗效进一步降低再发骨折发生率。

关键词: 预后营养指数, 老年女性, 椎体强化术, 骨质疏松性椎体压缩骨折

Abstract: Objective To investigate the prevalence of reoccurrence of vertebral fractures in the elderly female patients with osteoporotic vertebral compression fractures(OVCF) after percutaneous vertebral augmentation(PVA) and the related influencing factors. Methods A total of 205 elderly women with OVCF after PVA were enrolled, and the basic data including age, body mass index(BMI), admission blood count, blood biochemical index and bone mineral density(BMD) were collected. The investigation period was from 2 to 40 months after PVA. The patients were divided into re-fracture group and control group according to whether vertebral re-fracture occurred. The factors influencing the recurrence of vertebral fractures were analyzed by single factor analysis and multivariate Cox regression model, and the predictive value of the independent factors was calculated by Logistic regression, and the receiver operating chavactevistic (ROC) curve was drawn. Results The incidence rate of recurrent vertebral fractures in the elderly women with OVCF after PVA was 20.5%, and prognostic nutritional index(PNI), BMD, age, and the use of anti-osteoporosis drugs were the independent influencing factors of recurrent vertebral fractures after PVA. The risk of re-fracture after PVA was lower in patients with high PNI compared with those with low PNI. There was an interaction between PNI and the use of anti-osteoporosis drugs, and the high PNI group had better efficacy. Compared with the model without PNI, the area of the ROC curve of the model with PNI was increased by 0.065(0.003-0.127). Conclusions High PNI is a protective factor for recurrent vertebral fractures after PVA in the elderly female patients with OVCF, and has predictive value for vertebral re-fracture after PVA, which can reduce the incidence of re-fracture by improving the efficacy of anti-osteoporosis drugs.

Key words: prognostic nutritional index, elderly women, percutaneous vertebral augmentation, osteoporotic vertebral compression fracture

中图分类号:

R 683.2

徐凤周, 高开茜, 孙亮亮, 高学峰, 张雄, 刘永强, 周建伟. 预后营养指数对老年女性OVCF病人PVA术后再发椎体骨折的影响[J]. 实用老年医学, 2023, 37(5): 470-474.

XU Feng-zhou, GAO Kai-qian, SUN Liang-liang, GAO Xue-feng, ZHANG Xiong, LIU Yong-qiang, ZHOU Jian-wei. Effect of prognostic nutritional index on recurrent vertebral fractures after percutaneous vertebral augmentation in elderly female patients with osteoporotic vertebral compression fractures[J]. Practical Geriatrics, 2023, 37(5): 470-474.

参考文献

[1] YE L Q, LIAN G D, JIANG X B, et al. Risk factors for the occurrence of insufficient cement distribution in the fractured area after percutaneous vertebroplasty in osteoporotic vertebral compression fractures[J]. Pain Physician, 2018,21(1): E33-E42.
[2] AVERY M J, KIMBERLY B. Efficacy of routine biopsy at vertebral augmentation for compression fracture repair in the early detection of malignancy in presumed benign vertebral compression fracture[J]. J Clin Densitom, 2018,21(1): 24.
[3] GUENOUN D, FOURÉ A, PITHIOUX M, et al. Correlative analysis of vertebral trabecular bone microarchitecture and mechanical properties: a combined ultra-high field(7 Tesla) MRI and biomechanical investigation[J]. Spine(Phila Pa 1976), 2017, 42(20): E1165-E1172.
[4] VOORMOLEN M H, LOHLE P N, JUTTMANN J R, et al. The risk of new osteoporotic vertebral compression fractures in the year after percutaneous vertebroplasty[J]. J Vasc Interv Radiol, 2006, 17(1): 71-76.
[5] NAGAI T, UEI H, NAKANISHI K. Association among geriatric nutritional risk index and functional prognosis in elderly patients with osteoporotic vertebral compression fractures[J]. Indian J Orthop, 2022, 56(2): 338-344.
[6] 郭小荣, 郭成龙, 崔巧梅, 等. 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[J]. 中国骨质疏松杂志, 2020, 26(7): 967-971.
[7] 刘键, 李明东, 陈科, 等. 经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折围手术期并发症分析[J]. 国际老年医学杂志, 2021, 42(3): 148-151.
[8] 钱三祥, 薛刚, 路友群, 等. 预后营养指数对老年骨质疏松性椎体压缩骨折术后近期预后的影响[J]. 颈腰痛杂志, 2022, 43(2): 229-232.
[9] 谢华, 李继春, 何劲, 等. 骨水泥分布对椎体成形手术后疗效影响的研究[J]. 中华骨科杂志, 2017, 37(22): 1400-1406.
[10] TAKAHASHI S, HOSHINO M, TERAI H, et al. Differences in short-term clinical and radiological outcomes depending on timing of balloon kyphoplasty for painful osteoporotic vertebral fracture[J]. J Orthop Sci, 2018, 23(1): 51-56.
[11] JARVINEN T L, MICHAELSSON K, ASPENBERG P, et al. Osteoporosis: the emperor has no clothes[J]. J Intern Med, 2015, 277(6): 662-673.
[12] GENG Y, QI Q, SUN M, et al. Prognostic nutritional index predicts survival and correlates with systemic inflammatory response in advanced pancreatic cancer[J]. Eur J Surg Oncol, 2015, 41(11): 1508-1514.
[13] 颜歆, 潘华, 彭宏伟. 倾向评分匹配法探讨预后营养指数与乳腺癌患者术后预后的关系[J]. 中国肿瘤外科杂志, 2020,12(5): 448-451.
[14] 郭昕宇, 朱娜, 郝定均. 低蛋白血症与骨质疏松相关性的研究进展[J]. 中国骨质疏松杂志, 2018,24(8): 1103-1106.
[15] 朱娜, 崔蕾, 郝定均, 等. 低蛋白血症和骨折、骨质疏松相关性研究[J]. 中国骨质疏松杂志, 2019,25(12): 1821-1824.
[16] AFSHINNIA F, PENNATHUR S. Association of hypoalbuminemia with osteoporosis: analysis of the National Health and Nutrition Examination Survey[J]. J Clin Endocrinol Metab, 2016, 101(6): 2468-2474.
[17] GOISSER S, SCHRADER E, SINGLER K, et al. Malnutrition according to Mini Nutritional Assessment is associated with severe functional impairment in geriatric patients before and up to 6 months after hip fracture[J]. J Am Med Dir Assoc, 2015, 16(8): 661-667.
[18] 程婷, 张升校, 牛红青, 等. 类风湿关节炎并发骨质疏松患者外周血淋巴细胞亚群的表达水平[J]. 中华骨质疏松和骨矿盐疾病杂志, 2020, 13(1): 8-14.
[19] 高坤, 余伟吉, 李全, 等. 中性粒细胞计数与淋巴细胞计数的比值与骨质疏松症相关性的研究[J]. 中国骨质疏松杂志, 2019,25(8): 1134-1137.
[20] 张玉梅, 何洁, 冯筱青, 等. β-羟基-β-丁酸甲酯对老年髋关节置换病人跌倒风险的干预效果[J]. 肠外与肠内营养, 2018, 25(4): 218-222.
[21] TEUBER H, TIZIANI S, HALVACHIZADEH S, et al. Single-level vertebral kyphoplasty is not associated with an increased risk of symptomatic secondary adjacent osteoporotic vertebral compression fractures: a matched case-control analysis[J]. Arch Osteoporos, 2018,13(1): 82.
[22] LESNYAK O, GLADKOVA E, ALEKSANDROV N, et al. Treatment of high fracture risk patients in routine clinical practice[J]. Arch Osteoporos, 2020, 15(1): 184.
[23] 徐凤周, 范金鹏, 高开茜, 等. 维生素K2联合咪达普利对合并高血压的老年女性骨质疏松患者的疗效观察[J]. 中国骨质疏松杂志, 2021, 27(2): 269-274.

预后营养指数对老年女性OVCF病人PVA术后再发椎体骨折的影响

Effect of prognostic nutritional index on recurrent vertebral fractures after percutaneous vertebral augmentation in elderly female patients with osteoporotic vertebral compression fractures

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