中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (30): 4837-4841.doi: 10.12307/2024.646

• 人工假体 artificial prosthesis • 上一篇    下一篇

髋关节翻修后低蛋白血症的危险因素及列线图预测模型建立

陈俊峰1，谢荣臻2，洪尉师3，孙  钰3   

  1. 1扬州大学医学院，江苏省扬州市   225000；2遵义医科大学医学与科技学院，贵州省遵义市   563000；3扬州大学附属苏北人民医院骨科，江苏省扬州市   225000
  • 收稿日期:2023-06-25 接受日期:2023-08-30 出版日期:2024-10-28 发布日期:2023-12-27
  • 通讯作者: 孙钰，博士，副主任医师，扬州大学附属苏北人民医院骨科，江苏省扬州市 225000
  • 作者简介:陈俊峰，男，1976年生，湖北省天门市人，汉族，2000年华中科技大学同济医学院毕业，主任医师，主要从事关节及运动医学方面的研究。

Risk factors and establishment of a nomogram prediction model for hypoproteinemia after hip revision

Chen Junfeng1, Xie Rongzhen2, Hong Weishi3, Sun Yu3   

  1. 1School of Medicine, Yangzhou University, Yangzhou 225000, Jiangsu Province, China; 2School of Medicine and Technologe, Zunyi Medical University, Zunyi 563000, Guizhou Province, China; 3Department of Orthopedics, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou 225000, Jiangsu Province, China
  • Received:2023-06-25 Accepted:2023-08-30 Online:2024-10-28 Published:2023-12-27
  • Contact: Sun Yu, MD, Associate chief physician, Department of Orthopedics, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou 225000, Jiangsu Province, China
  • About author:Chen Junfeng, Chief physician, School of Medicine, Yangzhou University, Yangzhou 225000, Jiangsu Province, China

PDF

14

摘要：


文题释义：

髋关节翻修：是在经过初次人工髋关节置换术后，因假体松动、假体周围骨折、假体周围感染等原因导致需要对既往安装的人工关节假体进行重新翻修、更换的一种手术方式，其手术难度远大于初次关节置换。
列线图：又称诺莫图，它是建立在多因素回归分析的基础上，将多个预测指标进行整合，然后采用带有刻度的线段，按照一定的比例绘制在同一平面上，从而用以表达预测模型中各个变量之间的相互关系。列线图将复杂的回归方程转变为可视化的图形，使预测模型的结果更具有可读性，方便对患者进行评估。


背景：髋关节翻修术创伤大，患者术后低蛋白血症发生率高，影响患者术后快速康复。

目的：探讨髋关节翻修患者围术期发生低蛋白血症的危险因素，为临床上早期甄别术后高风险低蛋白血症患者提供指导意义。
方法：按照纳入及排除标准共纳入行髋关节翻修术患者161例，根据术后是否出现低蛋白血症分为2组，低蛋白血症组76例，正常组85例，术后低蛋白血症发生率为47.2%。收集两组患者年龄、性别、体质量指数、骨质疏松、手术时间、术前红细胞、术前血红蛋白、术前白细胞、术前血小板、术前纤维蛋白原、术前C-反应蛋白、术前血沉、术前血钙、术前白蛋白、术后引流管放置情况、美国麻醉师协会评分、术后发生低蛋白血症情况等资料，利用SPSS软件进行多因素二元Logistic回归分析探讨导致髋关节翻修患者术后低蛋白血症的独立危险因素；通过R软件构建列线图预测模型，并绘制出受试者工作特征曲线、校准曲线以及决策曲线分析来评价模型。

结果与结论：①单因素分析结果显示，两组体质量指数、术前红细胞、术前血红蛋白、术前血小板、术前纤维蛋白原、术前C-反应蛋白以及手术时间方面差异有显著性意义(P < 0.05)；②多因素二元Logistic回归分析结果显示，体质量指数(OR=0.859，P=0.021)、手术时间(OR=1.010，P=0.002)、术前红细胞(OR=0.424，P=0.036)以及术前C-反应蛋白(OR=1.043，P=0.032)水平是影响髋关节翻修患者术后低蛋白血症的独立危险因素；③提示根据体质量指数、手术时间、术前红细胞和术前C-反应蛋白这4个独立危险因素，列线图可以有效预测髋关节翻修患者术后发生低蛋白血症的风险；该列线图预测模型具有良好的区分度和准确性，并可能为患者带来更好的临床净收益。

https://orcid.org/0009-0006-1133-1130 (陈俊峰) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 髋关节翻修术, 低蛋白血症, 危险因素, 列线图, 预测模型

Abstract: BACKGROUND: The high rate of postoperative hypoproteinemia in patients undergoing hip revision is associated with severe trauma, which affects the rapid recovery of patients.
OBJECTIVE: To investigate the risk factors of perioperative hypoproteinemia in patients with hip revision, and to provide guidance for early screening of high-risk patients with postoperative hypoproteinemia. 
METHODS: According to the inclusion and exclusion criteria, 161 patients who underwent hip revision were divided into hypoproteinemia group (76 cases) and normal group (85 cases). The rate of hypoproteinemia was 47.2%. Data such as age, gender, body mass index, osteoporosis, operation time, preoperative erythrocytes, preoperative hemoglobin, preoperative leukocytes, preoperative platelets, preoperative fibrinogen, preoperative C-reaction protein, preoperative sedimentation rate, preoperative blood calcium, preoperative albumin, postoperative drainage tube placement, American Society of Anesthesiologists score, and postoperative hypoproteinemia were collected. SPSS software was used to analyze the independent risk factors of hypoproteinemia after hip revision using multivariate binary logistic regression analysis. R software was used to construct the nomogram prediction model. Receiver operating characteristic curve and calibration curve and decision curve were drawn to evaluate the model. 
RESULTS AND CONCLUSION: (1) Univariate analysis results showed that body mass index, preoperative erythrocytes, preoperative hemoglobin, preoperative platelets, preoperative fibrinogen, preoperative C-reaction protein, and operation time were significantly different between the two groups (P < 0.05). (2) Multivariate binary Logistic regression analysis results showed that body mass index (OR=0.859, P=0.021), operation time (OR=1.010, P=0.002), preoperative erythrocytes (OR=0.424, P=0.036), and preoperative C-reaction protein (OR=1.043, P=0.032) levels were independent risk factors for postoperative hypoproteinemia in patients with hip revision. (3) Based on four independent risk factors: body mass index, operation time, preoperative erythrocytes and preoperative C-reaction protein, the nomogram can effectively predict the risk of hypoproteinemia after hip revision. This nomogram prediction model has good differentiation and accuracy, and may lead to better clinical net benefits for patients.

Key words: hip revision, hypoproteinemia, risk factor, nomogram, prediction model

中图分类号: