中医正骨2025，Vol.37Issue(3)：23-28,38,7.
老年膝骨关节炎合并肌少症的影响因素分析及风险预测模型构建
Influencing factors and a risk forecasting model for knee osteoarthritis complicated with sarcopenia in the aged
摘要
Abstract
Objective:To explore the influencing factors of knee osteoarthritis complicated with sarcopenia in the aged,and to construct a risk prediction model for KOA complicated with sarcopenia in the aged.Methods:The KOA patients hospitalized at The First People's Hospital of Yibin from June 2020 to December 2024 were selected as the subjects.The ones admitted from June 2020 to June 2024 were as-signed into the model group(for model building),while those from July 2024 to December 2024 into the validation group(for model valida-tion).The information of the patients,including gender,age,body mass index(BMI),KOA duration,Kellgren-Lawrence(K-L)grade,protein intake,knee pain visual analogue scale(VAS)score,Western Ontario and McMaster Universities osteoarthritis index(WOMAC)grade,smoking,alcohol abuse,standardized treatment,regular exercise,combined with underlying diseases,calcium supplementation,and vitamin D supplementation,was collected,and the sarcopenia was diagnosed among the included KOA patients using the diagnostic methods developed by the Asian Working Group for Sarcopenia(AWGS).According to the results,the KOA patients with and without sarcopenia in model group were subgrouped into a sarcopenia group and a non-sarcopenia group.After that,a single-factor analysis was conducted on the extrac-ted information of patients in the 2 subgroups,followed by a Lasso regression analysis on the factors with statistically significant differences between the 2 subgroups,based on which a multi-factor logistic regression analysis on the factors screened by Lasso regression analysis was performed.According to the findings,a nomogram prediction model for KOA complicated with sarcopenia in the aged was constructed using the R language and rms package,and the discrimination and calibration performance of the nomogram prediction model were analyzed and evaluated by using the receiver operating characteristic(ROC)curve and Hosmer-Lemeshow goodness-of-fit(GOF)test based on the data of model group and validation group,respectively.Results:Seventy-seven patients were enrolled in the validation group,and 675 ones in model group,among which 196 ones in sarcopenia group,and 479 ones in non-sarcopenia group.The single-factor analysis showed significant differences between sarcopenia group and non-sarcopenia group in the age,KOA duration,K-L grade,protein intake,knee pain VAS score,WOMAC grade,alcohol abuse,standardized treatment,regular exercise,combined with underlying diseases,and vitamin D supplementation(73.8±5.2 vs 68.3±4.6 years,t=12.921,P=0.000;26.5±3.9 vs 19.6±4.6 months,t=19.768,P=0.000;x2=16.171,P=0.000;59.3±6.5 vs 63.9±6.3 g/day,t=8.475,P=0.000;5.6±1.7 vs 4.7±1.3 points,t=7.109,P=0.000;x2=8.627,P=0.013;x2=8.082,P=0.004;x2=4.076,P=0.043;x2=10.096,P=0.001;x2=10.822,P=0.004;x2=7.644,P=0.006).After Las-so regression analysis,age,KOA duration,K-L grade,protein intake,knee pain VAS score,regular exercise,and WOMAC grade were identi-fied as the variables for predicting sarcopenia in the aged KOA patients.The multi-factor logistic regression analysis showed that the age,KOA duration,and knee pain VAS score were the risk factors,while the protein intake was a protective factor for KOA complicated with sar-copenia in the aged.The area under the ROC curve of the nomogram prediction model for KOA complicated with sarcopenia in the aged validated based on the data of model group and validation group was 0.865(P=0.000,95％CI(0.837,0.892))and 0.762(P=0.000,95％CI(0.709,0.811)),respectively.The Hosmer-Lemeshow GOF test showed that the maximum and minimum offsets was 0.037 and 0.011(P=0.885),respectively,in model group,and 0.058 and 0.031(P=0.773),respectively,in validation group.Conclusion:Age,KOA duration,and knee pain VAS score are the risk factors for KOA complicated with sarcopenia,while the protein intake is a protective factor against sarcopenia in the aged KOA patients.The nomogram prediction model constructed based on the above factors has a high clini-cal applied value in predicting the risk for sarcopenia in the aged KOA patients.关键词
骨关节炎,膝/肌肉衰减征/老年人/Logistic模型/因素分析,统计学/列线图表/风险/预测Key words
osteoarthritis,knee/sarcopenia/aged/logistic models/factor analysis,statistical/nomograms/risk/forecasting引用本文复制引用
陈敏,余泽芸,宋丹,周礼,熊小琴..老年膝骨关节炎合并肌少症的影响因素分析及风险预测模型构建[J].中医正骨,2025,37(3):23-28,38,7.基金项目
四川省卫生和健康委员会科研课题(21PJ011) （21PJ011）
