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    肥胖增加膝骨关节炎患者行膝关节置换的风险
    发布时间:[2016-04-01 17:11] 点击次数:

    作者:Kirsten M. Leyland  翻译:于若寒  校正:刘佩玲                          

    发布者:闫冰  审校者:张舸

     

    摘要

    目的:

    目前不确定在确诊骨关节炎(OA)到需要膝关节置换手术的过程中肥胖起怎样的作用。本研究目的是评估一个社区内初诊为骨关节炎的超重和肥胖患者进行膝关节置换手术的相对风险。

     

     

    方法:

    患者来自于基础保障研究形成信息系统数据库,该数据库包含了由医疗保健专业人员收集的西班牙加泰罗尼亚地区>550万人群的临床信息。研究纳入了2006年-2011年在基础医疗新诊断的膝骨关节炎患者。根据疾病国际分类标准的第九版确定是否需膝关节置换。根据身体质量指数拟定需行膝关节置换的多因素Cox回归模型,并纠正相关的混杂因素。计算人群比例危险度。

     

     

    结果:

    对105189例患者进行随访,中位随访时间是2.6年(四份位间距1.3-4.2)。这些患者中,7512例(7.1%)接受膝关节置换。与正常体重患者相比,世界卫生组织体质指数分类标准对膝关节置换校正的风险比(HR)和95%可信区间(95%CI)分别是超重1.41 (95% CI 1.27–1.57)、肥胖Ⅰ1.97 (95% CI 1.78–2.18)、肥胖Ⅱ2.39 (95% CI 2.15–2.67)、肥胖Ⅲ2.67 (95% CI 2.34–3.04)。体质指数对膝关节置换风险的影响在年轻患者中更常见。肥胖对膝骨关节炎相关的膝关节置换的人群危险度是31%。

     

     

    结论:

    与正常体重患者相比,超重和肥胖患者行膝关节置换手术的风险分别增加>40%和100%。在年轻患者中的相关性更大。降低体重疗法可使31%的膝骨关节炎患者免于膝关节置换手术。

     

     

    附原文:

    Objective It is unclear what impact obesity has on the progression of knee osteoarthritis (OA) from diagnosis to knee replacement surgery. This study was undertaken to examine the relative risk of knee replacement surgery in overweight and obese patients who were newly diagnosed as having knee OA in a community setting.Methods Subjects were selected from the Information System for Development of Primary Care Research database, which compiles comprehensive clinical information collected by health care professionals for >5.5 million people in Catalonia, Spain (80% of the population). Patients newly diagnosed as having knee OA in primary care between 2006 and 2011 were included. Knee replacement was ascertained using International Classification of Diseases, Ninth Revision, Clinical Modification codes from linked hospital admissions data. Multivariable Cox regression models were fitted for knee replacement according to body mass index (BMI), and were adjusted for relevant confounders. Population proportional attributable risk was calculated. Results A total of 105,189 participants were followed up for a median of 2.6 years (interquartile range 1.3–4.2). Of these patients, 7,512 (7.1%) underwent knee replacement. Adjusted hazard ratios and 95% confidence intervals (95% CIs) for knee replacement for the World Health Organization BMI categories were 1.41 (95% CI 1.27–1.57) for overweight, 1.97 (95% CI 1.78–2.18) for obese I, 2.39 (95% CI 2.15–2.67) for obese II, and 2.67 (95% CI 2.34–3.04) for obese III compared to normal weight. The effect of BMI on risk of knee replacement was stronger among younger participants. The population attributable risk of obesity for knee OA–related knee replacement was 31.0%. Conclusion Overweight and obese patients are at >40% and 100% increased risk of knee replacement surgery, respectively, compared to patients with normal weight. This association is even stronger in younger patients. Weight reduction strategies could potentially reduce the need for knee replacement surgery by 31% among patients with knee OA.

     

     

    引自:

    Leyland, K. M., Judge, A., Javaid, M. K., Diez-Perez, A., Carr, A., Cooper, C., Arden, N. K. and Prieto-Alhambra, D. (2016), Obesity and the Relative Risk of Knee Replacement Surgery in Patients With Knee Osteoarthritis: A Prospective Cohort Study. Arthritis & Rheumatology, 68: 817–825.

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