老年膝关节骨性关节炎患者跌倒风险临床预测规则的构建  

Development of a clinical prediction rule for fall risk in elderly patients with knee osteoarthritis

作　　者：姜丽萍 陆皓[2] 汉瑞娟[2] 李旭[3] JIANG Liping;LU Hao;HAN Ruijuan;LI Xu(School of Nursing,Ningxia Medical University,Yinchuan 750004,China;Nursing Department,The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army,Lanzhou 730050,China;Sports Medicine/Joint Surgery Department,The First Hospital,China Medical University,Shenyang 110001,China)

机构地区：[1]宁夏医科大学护理学院,银川750004 [2]中国人民解放军联勤保障部队第940医院护理部,兰州730050 [3]中国医科大学附属第一医院运动医学/关节外科,沈阳110001

出　　处：《中国医科大学学报》2020年第6期541-545,共5页Journal of China Medical University

基　　金：甘肃省自然科学基金(1606RJZA174);辽宁省教育厅基础研究项目(JC2019001)。

摘　　要：目的研究老年膝关节骨性关节炎(KOA)患者发生跌倒的危险因素,并构建相关的临床预测规则(CPR)。方法选取139例老年KOA患者,行肌肉力量测试、单腿站立试验(OLST)、五次坐立测试(FTSST)和6分钟步行试验(6mWT),同时采集患者人口学和临床信息。以患者过去一年内是否发生跌倒为因变量,以人口学、病情等为混杂因素,以肌肉力量测试、OLST、FTSST和6mWT得分为自变量进行二元logistic回归,考察跌倒的独立危险因素。受试者工作特性(ROC)曲线分析考察独立危险因素的临界值。自变量按ROC分析的临界值转化为二分类变量,使用二分类变量获取CPR。结果OLST(OR=1.42)和FTSST(OR=1.74)是发生跌倒的独立危险因素,临界值分别为5.2 s和7.8 s。当两者均为阳性时,阳性预测值率为88.3%(AUC=0.875,P<0.001)。结论OLST≤5.2 s和FTSST≥7.8 s是老年KOA患者发生跌倒的独立危险因素。本研究获得的CPR可以有效预测老年KOA患者发生跌倒的风险。Objective To investigate the risk factors of falls in elderly patients with knee osteoarthritis(KOA)and to construct a relevant clinical prediction rule(CPR).Methods Demographic and clinical information was collected from 139 elderly KOA patients underwent muscle strength test,one-legged standing test(OLST),five-time sitting test(FTSST),and 6-minute walking test(6mWT).The independent risk factors of falls were evaluated using logistic regression analysis with the patient’s fall history in the past year as the dependent variable;demography and illness as confounding factors;and muscle strength test,OLST time,FTSST time,and 6mWT score as independent variables.Then,the critical value of independent risk factors was examined with a receiver-operating characteristic(ROC)analysis.The independent variable was converted into a dichotomous variable according to the critical value of the ROC analysis,and the dichotomous variable was used to obtain the CPR.Results OLST(OR=1.42)and FTSST times(OR=1.74)were independent risk factors of falls,with thresholds of 5.2 and 7.8 s,respectively.When both were positive,the positive predictive value rate was 88.3%(area under the curve=0.875,P<0.001).Conclusion OLST time of≤5.2 s and FTSST time of≥7.8 s were independent risk factors of falls in elderly patients with KOA.The CPR obtained in this study effectively predicted the risk of falls in the elderly patients with KOA.

关 键 词：膝关节骨性关节炎 临床预测规则 跌倒 

分 类 号：R684.3[医药卫生—骨科学]