全膝关节置换术患者术前营养状况与假体周围感染相关性分析

Correlation between preoperative nutritional status and periprosthetic joint infection in patients undergoing total knee arthroplasty

目的 探究患者择期全膝关节置换术术前营养指标与术后假体周围感染(periprosthetic joint infection, PJI)的相关性,发现PJI发生的危险因素,通过优化术前营养指标来预防并降低PJI的发生率。方法 对2017年1月至2019年6月在河南省人民医院择期行全膝关节置换术的548例患者进行评估,评估患者术前营养状况的实验室指标,包括低白蛋白血症(白蛋白<35 g/L)、贫血(男性:血红蛋白<120 g/L;女性:血红蛋白<110 g/L)、总淋巴细胞计数(TLC<1.5×10^(9))、低总胆固醇(TC<3.9 mmol/L)、高总胆固醇(TC>5.18 mmol/L)及体重指数(BMI)。采用SPSS 26.0对数据进行统计分析,卡方检验用于检查术前存在的营养并发症和术后假体感染之间相关性,并将与术后假体感染显著相关的术前营养并发症行进一步的逻辑回归分析。结果 完整收集术前实验室指标的548例患者中,低白蛋白血症、贫血、低淋巴细胞计数、血清低总胆固醇、血清高总胆固醇、超重及肥胖的发生率分别为8.8%、13.9%、18.8%、20.1%、37.6%、43.1%、35.9%,通过SPSS 26.0对数据进行统计分析,卡方检验结果表明高总胆固醇、低白蛋白血症及贫血和术后假体周围感染之间存在显著相关性,而低总淋巴细胞、血清低总胆固醇、低重及超重、肥胖等与PJI之间并无明显相关性,进一步逻辑回归分析表明,术前高总胆固醇血症、低白蛋白血症及贫血是术后假体周围感染的危险指标。结论 术前高总胆固醇血症、低白蛋白血症及贫血是择期行全膝关节置换术患者术后发生假体周围感染的危险因素,也可以作为术后发生假体感染的预测因子。

Objective To investigate the correlation between preoperative nutritional parameters and periprosthetic joint infection(PJI) in patients undergoing elective total knee arthroplasty, to identify risk factors for the occurrence of PJI,and to prevent and reduce the incidence of PJI by optimizing preoperative nutritional parameters.Methods Totally 548 patients who underwent elective total knee arthroplasty in our hospital from January 2017 to June 2019 were evaluated.Laboratory indicators to evaluate patients’ preoperative nutritional status, including hypoalbuminemia(albumin <35 g/L),anemia(male: hemoglobin <120 g/L;female: hemoglobin <110 g/L),total lymphocyte count(TLC <1.5 × 10^(9)),low total cholesterol(TC <3.9 mmol/L),high total cholesterol(TC >5.18 mmol/L) and body mass index(BMI).The data were statistically analyzed by SPSS version 26,and chi-square test was used to check the correlation between preoperative nutritional complications present and prosthetic joint infection, and preoperative nutritional complications significantly associated with periprosthetic joint infection were further logistic regression analysis.Results Among the 548 patients with complete collection of preoperative laboratory indices, the prevalence of hypoalbuminemia, anemia, low lymphocyte count, low serum total cholesterol, high serum total cholesterol, overweight and obesity were 8.8%,13.9%,18.8%,20.1%,37.6%,43.1% and 35.9%,respectively, and the data were statistically analyzed by SPSS 26.0,the results of the chi-square test showed that there was a significant correlation between high total cholesterol, hypoalbuminemia, anemia and periprosthetic joint infection, while there was no significant correlation between low total lymphocytes, low serum total cholesterol, low and overweight, and obesity and PJI.Further logistic regression analysis showed that preoperative high total cholesterolemia, hypoalbuminemia and anemia were risk indicators for periprosthetic joint infection.Conclusion Preoperative hyper-total cholesterolemia, hypoalbuminemia and anemia are risk factors for periprosthetic joint infection in patients undergoing elective total knee arthroplasty and can also be used as predictors of periprosthetic joint infection.