国内六大行政区域六城市中老年人群膝关节骨性关节炎患病危险因素比较

Comparison of the risk factors for knee osteoarthritis in middle-aged and elderly populations from six cities of six administration regions of China

目的:了解中国不同地区间中老年人群膝关节骨性关节炎患病危险因素。方法:调查时间为2005-07/08。①从中国六大行政区(西北,华北,华东,中南,东北,西南)选出六城市(西安,石家庄,上海,广州,哈尔滨市,成都),用分层多阶段整群抽样方法,抽取6218名40岁及以上具有正式户口常住男女人群进行膝关节骨性关节炎的流行病学问卷调查(包括一般情况、现病史、既往史、体格检查、X射线片检查情况和疾病诊断6个方面,共计94个问题141个变量指标),并对其中4808名有症状者进行X射线平片膝正侧位投照。②膝关节骨性关节炎诊断标准为临床症状阳性加X射线Kellgren&Lawrence分级二级及以上者。③计算患病率,并采用EpiInfo6.0和SPSS10.0软件对其中83个变量进行多因素非条件Logistic回归分析,表示疾病与暴露因素之间联系强度的指标用比值比(OR),若OR>1,说明疾病发生危险性增加,与暴露因素呈正关联;若OR<1,说明疾病发生危险性减少,与暴露因素呈负关联。结果:①六城市膝关节骨性关节炎总患病率为15.6%,其中西安7.7%,石家庄11.2%,上海9.8%,广州30.5%,哈尔滨16.9%,成都17.5%,各城市患病率比较差异显著(P<0.01)。②Logistic回归分析膝关节骨性关节炎在大部分城市有共同的危险因素如年龄大(OR=1.032～1.181),使用蹲坑排便年限长(OR=1.021～1.077),体质量高(OR=1.048～1.073),和开始饮酒年龄大(OR=1.008～1.028);而从事专职体育运动(OR=1.651,西安),骨质疏松病史(OR=3.311,石家庄),吸烟(OR=2.654,石家庄),类风湿关节炎病史(OR=4.964,上海),文化程度高(OR=2.593,上海),女性(OR=2.510,广州),姐妹骨关节炎史(OR=13.251,哈尔滨),母亲骨关节炎史(OR=5.683,成都)等危险因素分别在不同地区出现.结论:年龄大、使用蹲坑排便年限长、体质量高和开始饮酒年龄大是中国六地区膝关节骨性关节炎患病的共同危险因素,同时,不同地区主要危险因素又有一定差异。

AIM： To understand the risk factors of knee osteoarthritis in the middle-aged and elder population in different areas of China. METHODS： The investigation was performed from July to August 2005. ①A total of 6 218 persons who had formal residence certification and over 40 years old were enrolled from 6 cities （Xi＇an, Shijiazhuang, Shanghai, Guangzhou, Harbin and Chengdu） of 6 administration regions （northwest, northern China, eastern China, central south, northeast and southwest） of China with stratified-multi-steps-cluster sampling method. They received knee osteoarthritis epidemiology investigation （containing general condition, present history, past history, physical inspection, X-ray inspection and disease diagnosis, totally 94 problems and 141 variance indexes）. 4 808 persons with symptoms received X-ray in knee. ②Diagnostic criterion of knee osteoarthdtis was positive clinical symptom as well as at least two grades of X-ray Kellgren ＆ Lawrence. ③lncidence rate was calculated. The 83 variances were analyzed with multiple factors non-conditional Logistic regression analysis with Epilnfo 6.0 and SPSS 10.0 softwares. Odds ratio （OR） was used to express the contacted intensity between disease and exposed factors. OR 〉 1 indicated that risk of disease increased, and had positive correlation with exposed factors. OR 〈 1 indicated that risk of disease decreased, and had negative correlation with exposed factors. RESULTS： ①The total knee osteoarthritis prevalence rate was 15.6% in the six cities, of which it was 7.7% in Xi＇an, 11.2% in Shijiazhuang, 9.8% in Shanghai, 30.5% in Guangzhou, 16.9% in Harbin and 17.5% in Chengdu. There was significant difference in the prevalence rate in each city （P 〈 0.01）. ②The most common risk factors of knee osteoarthritis in six cities were old age （OR=1.032-1.181）,stay to excrete long （OR=1.021-1.077）, high body mass （OR =1.048-1.073） and to start drink years （OR =1.008-1.028）, sport worker （OR =1.651,Xi＇an）, history of osteoporosis （OR =3.311, Shijiazhuang）, smoking （OR =2.654 ,Shijiazhuang）, history of rheumatoid osteoarthritis （ OR =4.964,Shanghai）, high education （ OR =2.593,Shanghai）,women （ OR = 2.510 ,Guangzhou）, history of osteoarthritis in sisters （ OR =13.251, Harbin）and history of osteoarthritis in mother （OR =5.683,Chengdu）exposed in different cities analyzed with Logistic regression analysis. CONCLUSION： Some common risk factors of knee osteoarthritis do exist in six cities in China such as old age, stay to excrete long, high body mass and to start drink years. Meanwhile, the main risk factor is different in different cities.