肥胖对骨关节炎行大关节置换患者术后炎性反应及内分泌代谢的影响  

Effects of obesity on the pain,inflammatory response and endocrine metabolism of joint replacementin patients with osteoarthritis

作　　者：沈永艳 王丽华 杨红航[3] 张占丰[3] SHEN Yongyan;WANG Lihua;YANG Honghang;ZHANG Zhanfeng(Central Blood Station of Huzhou,Huzhou 313000,Zhejiang,China;Wuxing District Hospital of Integrated Chinese and Western Medicine,Huzhou 313000,Zhejiang,China;Department of Orthopedics,the First People′s Hospital of Huzhou,Huzhou 313000,Zhejiang,China)

机构地区：[1]湖州市中心血站,湖州313000 [2]湖州吴兴区中西医结合医院,湖州313000 [3]湖州市第一人民医院骨科,湖州313000

出　　处：《医学研究与战创伤救治》2023年第5期514-518,共5页Journal of Medical Research & Combat Trauma Care

摘　　要：目的探讨肥胖对骨关节炎行大关节置换患者术后疼痛程度、炎症反应及内分泌代谢水平产生的影响。方法选取2016年6月~2021年6月湖州吴兴区中西医结合医院骨科收治的132例骨关节炎行大关节置换术的患者。依据BMI将患者分为肥胖组(BMI≥28.0 kg/m^(2),n=44)、超重组(24.0 kg/m^(2)≤BMI≤27.9 kg/m^(2),n=45)与正常组(18.0 kg/m^(2)≤BMI≤23.9 kg/m^(2),n=43)。三组患者均行大关节置换术,术后3、7及14天采用视觉模拟疼痛评分量表(VAS)评估并比较患者疼痛程度;手术前后比较三组炎性反应指标,包括IL-6、纤维蛋白原(Fg)、C-反应蛋白(CRP)、肿瘤坏死因子-a(TNF-a);比较三组血清脂肪因子水平,包括瘦素(LEP)、脂联素(ADP)及抵抗素(IR)水平;采用Pearson相关分析血清炎性指标、脂肪因子水平与术后3天VAS评分之间的相关性。结果术后3天炎性介质及血清脂肪因子水平比较,肥胖组与超重组血清IL-6、CRP、TNF-a及Fg水平,血清LEP、ADP及IR显著高于正常组(P<0.05)。术后3天、7天与14天疼痛程度比较,三组VAS评分随时间变化而逐渐降低,且组内各时点比较差异有统计学意义(P<0.05);肥胖组与超重组VAS评分显著高于正常组(P<0.05)。Pearson相关分析得出,术后血清炎性介质、脂肪因子水平与疼痛程度均存在显著正相关(P<0.05)。结论肥胖合并骨关节炎患者接受大关节置换术后早期炎性反应更明显,疼痛程度更高,建议肥胖患者行大关节置换术前控制体重。Objective To investigate whether obesity affects the degree of pain,inflammatory response,and endocrine metabolism in patients with osteoarthritis undergoingjoint replacement.Methods 132 patients were included,who were with osteoarthritis and underwent joint replacement in our hospital from June 2016 to June 2021.According to body mass index(BMI),the patients were divided into the obesity group(BMI≥28.0 kg/m^(2)in 44 cases),overweight group(24.0 kg/m^(2)≤BMI≤27.9 kg/m^(2)in 45 cases)and normal group(18.0 kg/m^(2)≤BMI≤23.9 kg/m^(2)in 43 cases).All patients underwent joint replacement.On day 3,7 and 14 afteroperation,the pain degree was evaluated and compared by Visual Analog Pain Scale(VAS);The inflammatory response indexes were compared before and after operation,including interleukin-6(IL-6),fibrinogen(FG),C-reactive protein(CRP),tumor necrosis factor-A(TNF-a);The levels of serum adipokines,including leptin(LEP),adiponectin(ADP)and resistin(IR),were compared among three groups.Pearson correlation was used to analyze the correlation between postoperative serum inflammatory indexes,adipokine levels,and VAS scoreon day 3 after operation.Results On day 3 after operation,the levels of IL-6,CRP,TNF-a,FG,LEP,ADP and IR in the obese group and overweight group were significantly higher than those ofthe normal group(P<0.05);The levels of serum adipokines in obese group andoverweightgroup were significantly higher than those in normal group(P<0.05);Allpain scores reduced over time,and the pain scores of obese group and overweight group were significantly higher than those of normal group on day 3,7 and 14 after the operation(P<0.05);Pearson correlation analysis showed that there was a significant positive correlation between the levels of serum inflammatory mediators,adipokines and the degree of pain(P<0.05).Conclusion the levels of inflammatory indexes,and pain in obese patients with osteoarthritis are higher than those of normal patients,therefore,the body mass of obese patients should be controlled before join

关 键 词：大关节置换术 肥胖 炎性反应 内分泌代谢 疼痛 

分 类 号：R687.4[医药卫生—骨科学]