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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 651 -658. doi: 10.3877/cma.j.issn.1674-134X.2019.06.001

所属专题： 文献；

临床论著

营养评估预测髋关节骨关节炎手术后的短期运动功能
曹家俊1, 李俊1, 卢士学1, 丁少成1,†()   
  1. 1. 237000　六安，安徽省六安市第二人民医院
  • 收稿日期:2019-01-15 出版日期:2019-12-01
  • 通信作者: 丁少成
  • 基金资助:
    安徽高校自然科学研究项目(项目号KJ2019A1258); 安徽高校自然科学研究项目(KJ2018B02); 安徽高校自然科学研究项目(KJ2017A909)

Nutritional assessment predictes short-term motor function in patients with hip osteoarthritis

Jiajun Cao1, Jun Li1, Shixue Lu1, Shaocheng Ding1,†()   

  1. 1. Liuan second people’s hospital, Liuan 237000, China
  • Received:2019-01-15 Published:2019-12-01
  • Corresponding author: Shaocheng Ding
  • About author:
    Corresponding author: Ding Shaocheng, Email:
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引用本文：

曹家俊, 李俊, 卢士学, 丁少成. 营养评估预测髋关节骨关节炎手术后的短期运动功能[J]. 中华关节外科杂志(电子版), 2019, 13(06): 651-658.

Jiajun Cao, Jun Li, Shixue Lu, Shaocheng Ding. Nutritional assessment predictes short-term motor function in patients with hip osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(06): 651-658.

目的

采用营养风险评估表(NRS-2002)与微型营养评定简法(MNA-SF)筛查行全髋关节置换术(THA)治疗的髋关节骨关节炎(OA)患者术前营养状况并探讨两种筛查工具的相关影响因素及评估何种营养筛查工具更加能预测术后短期运动功能。

方法

纳入标准：符合THA治疗适应证；住院时间≧24 h。排除标准：有认知障碍或精神疾病；严重慢性心血管疾病、肾衰竭；重度贫血和严重感染等。按纳入排除标准选取六安市第二人民医院在2016年1月至2018年6月期间就诊的115例择期THA治疗的老年髋关节OA患者(均为单髋)，营养状态筛查在患者入院24 h内进行。收集患者基本临床资料及血液检查指标。根据改良爱荷华辅助量表(mILAS)定义运动正常组与运动障碍组。NRS-2002评分与MNA-SF评分相关影响因子采用Pearson检验；运动能力预测因子采用多元Logistic回归分析。

结果

所有患者围手术期未发生院内死亡事件，手术均顺利完成，平均住院天数(5.7± 2.0)d。纳入患者mILAS量表平均分(1.4 ± 1.3)分，根据运动状况定义结果：运动正常组99例(86.1%)，运动障碍组16例(13.9%)。运动正常组年龄、体质指数(BMI)、白蛋白(ALB)、淋巴细胞(LYM)、血红蛋白(Hb)、NRS-2002评分数值均高于步态障碍组(t＝2.219、3.911、2.172、1.989、5.754、4.165，P<0.05)；MNA-SF评分数值低于步态障碍组(t＝6.049，P<0.05)。NRS-2002评分筛查结果显示：营养正常33例(28.7%)，营养不良风险67例(58.3%)，营养不良15例(13.0%)；MNA-SF评分筛查结果显示：营养正常47例(40.9%)，营养不良风险48例(41.7%)，营养不良20例(17.4%)。NRS-2002评分分组中年龄、BMI、ALB、PA、LYM、Hb数值比较差异具有统计学意义(F ＝4.741、F ＝11.632、F ＝9.391、F ＝6.167、Z＝4.112、F ＝15.538，P<0.05)；MNA-SF评分分组中年龄、BMI、ALB、PA、Hb数值比较差异具有统计学意义(F ＝4.435、12.182、16.925、4.006、6.746，P<0.05)。NRS-2002评分与MNA-SF评分负相关(r ＝－0.534，P＝0.000)。NRS-2002评分与BMI、ALB、Hb呈负相关(r ＝－0.211、－0.173、－0.258，P<0.05)，与LYM及PA呈弱负相关(r ＝－0.051、－0.009，P<0.05)。MNA-SF评分与BMI、ALB、Hb呈正相关(r＝0.303、0.285、0.204，P<0.05)。多元Logistic回归校正模型结果显示MNA-SF评分[OR＝3.970，95%CI(1.704，9.202)]、年龄[OR＝1.274，95%CI (1.036，1.568)]步行障碍发生相关(P<0.05)。

结论

本研究证实了髋关节OA患者术前营养不良或风险的发生率较高且营养状态与术后早期运动功能具有相关性，同时也证实了MNA-SF评分更加适合筛查髋关节OA患者术前营养状态。

关键词: 营养状况, 营养评价, 关节成形术，置换，髋, 功能恢复
Objective

To assessing which nutritional screening tools are better predictors of short-term postoperative motor function.

Methods

Inclusion creteria: indications of total hip arthrolasty(THA); hospital stay period ≧24 h. Exclusion creteria: the patients with cognitive disorders or mental diseases; severe cardiovascular diseases, renal failure, anemia or infection.In strict accordance with the inclusion and exclusion criteria, 115 elderly patients (all single hip OA) with elective THAadmitted to Lu’an Second People’s Hospital from January 2016 to June 2018 were selected. Nutritional status screening was performed within 24 h of admission. Basic clinical data and blood test indexes were collected. The normal and dyskinesia groups were defined according to the modifified Iowa level of assistance scale(mILAS). Pearson test was used to determine the influencing factors between nutrition risk assessment scale(NRS-2002) score and mini nutritional assessment short form(MNA-SF) score. The sports ability predictors were determined by multiple logistic regression.

Results

No in-hospital deaths occurred during the perioperative period. The surgeries were successfully completed. The average length of stay was (5.7±2.0) d. The mean score of mILAS scale was (1.4±1.3). The results were defined according to the exercise condition: 99 cases (86.1%) in the normal exercise group and 16 cases (13.9%) in the dyskinesia group. Age, body mass index (BMI), albumin (ALB), lymphocyte (LYM), hemoglobin (Hb) and NRS-2002 scores in the normal exercise group were higher than those in the dyskinesia group (t=2.219, 3.911, 2.172, 1.989, 5.754、6.746, P < 0.05), and MNA-SF scores were lower than those in the gait disorder group (t=6.049, P < 0.05). The results of NRS-2002 score screening showed normal nutrition in 33 cases (28.7%), malnutrition risk in 67 cases (58.3%) and malnutrition in 15 cases (13.0%). The results of MNA-SF score screening showed: 47 cases (40.9%) with normal nutrition, 48 cases (41.7%) with risk of malnutrition, and 20 cases (17.4%) with malnutrition.There were statistically significant differences in age, BMI, ALB, PA, LYM and Hb(F=4.741、F=11.632、F =9.391、F =6.167、Z=4.112、F=15.538, all P<0.05). There were statistically significant differences in age, BMI, ALB, PA and Hb in the mna-sf score group (t=4.435, 12.182, 16.925, 4.006, 6.746, P < 0.05). NRS-2002 score were negatively correlated with MNA-SF score (r=-0.534, P=0.000). NRS-2002 score were negatively correlated with BMI, ALB and Hb (r=-0.211, -0.173, -0.258, all P <0.05), and weakly negatively correlated with LYM and PA (r=-0.051, -0.009, P <0.05). MNA-SF score were positively correlated with BMI, ALB, and Hb (r=0.303, 0.285, 0.204, all P < 0.05). The results of multiple Logistic regression correction model showed that MNA-SF score [OR=3.970, 95%CI (1.704, 9.202) ] and age [OR=1.274, 95%CI ( 1.036, 1.568) ] were correlated with the occurrence of walking disorder (P < 0.05).

Conclusions

This study has confirmed a higher incidence of preoperative malnutrition or risk in patients with hip OA. Nutrition status is correlated with early postoperative motor function. MNA-SF score may be more suitable for screening preoperative nutritional status of patients with hip OA.

Key words: Nutritional status, Nutrition assessment, Arthroplasty, replacement, hip, Recovery of function
表1 患者一般资料比较
项目 运动正常组 运动障碍组 统计值 P值
例数 99 16 － －
年龄[岁，(±s)] 73.0±4.5 75.7±4.4 t＝2.217 <0.05
性别(男/女) 68/31 7/9 χ2＝3.776 >0.05
基础疾病(例) ? ? ? ?
? 高血压 11 2 χ2＝0.026 >0.05
? 糖尿病 7 1 χ2＝0.014 >0.05
? 冠心病 8 2 χ2＝0.339 >0.05
手术时间[h，(±s)] 125.7±22.5 112.0±21.4 t＝1.647 >0.05
术中出血量[ml，(±s)] 215.2±116.7 226.5±18.3 t＝1.346 >0.05
BMI[kg/m2，(±s)] 25.3±3.2 21.9±3.2 t＝3.911 <0.01
TC[mmol/L，(±s)] 5.0±2.5 5.4±2.6 t＝0.669 >0.05
TG[mmol/L，(±s)] 1.9±1.1 1.8±1.1 t＝0.109 >0.05
L[mmol/L，M(P25，P75)] 64.8(38.8，86.54) 79.68(56.58，99.85) Z＝1.025 >0.05
ALB[g/L，(±s)] 41.0±5.6 37.7±5.3 t＝2.172 <0.05
PA[mg/L，(±s)] 176.4±68.1 152.4±80.3 t＝1.274 >0.05
LYM[×1012个/L，(±s)] 1.7±1.9 1.2±0.6 t＝1.989 <0.05
Hb[g/L，(±s)] 133.3±15.2 115.4±19.2 t＝5.754 <0.01
NRS-2002评分[分，(±s)] 3.3±1.2 1.9±1.1 t＝4.165 <0.01
MNA-SF评分[分，(±s)] 12.0±1.5 7.8±2.6 t＝6.049 <0.01
表2 两种营养筛查工具筛查结果比较[例(%)]
评分 营养状态
正常 营养不良风险 营养不良
NRS-2002评分 33(28.7) 67(58.3) 15(13.0)
MNA-SF评分 47(40.9) 48(41.7) 20(17.4)
χ2值 3.757 6.278 0.842
P值 >0.05 <0.05 >0.05
表3 2种营养筛查工具分组临床资料比较(±s)
变量 NRS-2002评分
正常 营养不良风险 营养不良 统计值 P值
年龄[岁，(±s)] 72.7±3.8 72.8±4.7 76.5±3.9 F＝4.741 <0.01
性别(男/女) 17/16 42/25 9/6 χ2＝1.147 >0.05
基础疾病(例) ? ? ? ? ?
? 高血压 3 7 3 χ2＝1.342 >0.05
? 糖尿病 3 3 2 χ2＝1.818 >0.05
? 冠心病 4 3 3 χ2＝4.403 >0.05
手术时间[h，(±s)] 122.7±25.8 123.87±30.6 125.8±27.7 F＝0.061 >0.05
术中出血量[ml，(±s) 215.9±65.5 217.2±55.3 216.8±79.3 F＝0.005 >0.05
BMI[kg/m2，(±s)] 24.1±2.9 21.9±3.2 19.8±3.2 F＝11.632 <0.01
TC[mmol/L，(±s)] 6.0±3.2 5.1±2.2 4.5±2.6 F＝2.085 >0.05
TG[mmol/L，(±s)] 1.7±0.9 2.0±1.1 1.7±1.2 F＝1.109 >0.05
L[mmol/L，(±s)] 54.9±12.3 56.1±15.8 57.64±14.9 F＝0.271 >0.05
ALB[g/L，(±s)] 40.7±4.1 37.8±5.50 34.0±4.4 F＝9.391 <0.01
PA[mg/L，(±s)] 180.9±69.9 160.3±59.5 113.5±50.9 F＝6.167 <0.01
LYM[×1012个/L，M(P25，P75)] 1.7(1.1，1.6) 1.2(0.98，1.4) 0.9(0.6，1.1) Z＝4.112 <0.05
Hb[g/L，(±s)] 131.6±14.5 113.4±19.6 106.5±12.4 F＝15.538 <0.01
变量 MNA-SF评分
正常 营养不良风险 营养不良 统计值 P值
年龄[岁，(±s)] 74.5±4.1 72.1±3.9 73.7±3.8 F＝4.435 <0.05
性别[(男/女)，例] 27/20 29/19 12/8 χ2＝0.094 >0.05
基础疾病(例) ? ? ? ? ?
? 高血压 5 4 4 χ2＝1.952 >0.05
? 糖尿病 4 2 2 χ2＝1.039 >0.05
? 冠心病 5 3 2 χ2＝0.628 >0.05
手术时间[h，(±s)] 121.2±34.2 122.7±32.9 132.4±26.9 F＝0.877 >0.05
术中出血量[ml，(±s) 214.1±55.6 217.7±61.9 220.7±63.8 F＝0.096 >0.05
BMI[[kg/m2，(±s)] 24.5±3.3 22.3±2.9 20.5±3.3 F＝12.182 <0.01
TC[mmol/L，(±s)] 5.9±3.2 5.1±2.2 4.5±2.6 F＝2.139 >0.05
TG[mmol/L，(±s)] 1.9±1.1 1.8±1.0 1.8±1.0 F＝0.223 >0.05
L[mmol/L，(±s)] 52.8±13.7 55.46±14.27 57.1±14.2 F＝0.798 >0.05
ALB[g/L，(±s)] 41.6±5.9 38.4±4.4 33.9±4.1 F＝16.925 <0.01
PA[mg/L，(±s)] 170.7±88.5 145.4±67.4 115.6±52.1 F＝4.006 <0.05
LYM[1012个/L，(±s)] 1.5±1.8 1.4±0.5 1.2±0.5 F＝0.428 >0.05
Hb[g/L，(±s)] 128.3±16.3 120.2±20.1 110.8±18.0 F＝6.746 <0.01
图1 NRS-2002(营养风险评估表)　评分与MNA-SF(微型营养评定简法)评分散点图
表4 2种营养筛查工具与各变量的相关性
变量 NRS-2002评分 MNA-SF评分
r 95%CI P值 r 95%CI P值
年龄 0.024 (－0.104～1.204) 0.096 0.029 (－0.572，0.002) 0.069
BMI －0.211 (－1.611，－0.757) 0.000 0.303 (0.464，0.829) 0.000
ALB －0.173 (－2.436，－1.028) 0.000 0.285 (0.213，0.888) 0.001
LYM －0.051 (－0.381，－0.034) 0.019 0.033 (0.001，0.158) 0.053
PA －0.009 (－9.911，－0.054) 0.000 0.026 (－0.581，9.417) 0.083
Hb －0.258 (－1.140，－5.265) 0.000 0.204 (1.974，4.273) 0.000
图2 运动障碍预测未校正与校正模型分析结果。Adjusted Model1-MNA-SF评分(微型营养评定简法)与NRS-2002评分(营养风险评估表)　同时进入模型；Adjusted Model2-NRS-2002评分、NA-SF评分、年龄、BMI、ALB、LYM、Hb同时进入模型；BMI-身体质量指数；ALB-白蛋白；LYM-淋巴细胞；Hb-血红蛋白
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