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

作　　者：徐凤周 高开茜 孙亮亮 高学峰 张雄 刘永强 周建伟 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;Department of General Internal Medicine,Shijiazhuang Fifth Hospital,Shijiazhuang 050021,China)

机构地区：[1]石家庄市人民医院骨科,河北省石家庄市050011 [2]石家庄市第五医院内科,河北省石家庄市050021

出　　处：《实用老年医学》2023年第5期470-474,共5页Practical Geriatrics

基　　金：石家庄市科技支撑计划(211200823)。

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。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.

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 

分 类 号：R683.2[医药卫生—骨科学]