代谢综合征与全膝关节置换术后深静脉血栓形成相关性研究

Study on the Relation between Metabolic Syndrome and Deep Vein Thrombosis after Total Knee Arthroplasty

目的探讨全膝关节置换术(total knee arthroplasty,TKA)后总深静脉血栓(deep vein thrombosis,DVT)及症状性DVT的发病率与代谢综合征(metabolic syndrome,MS)各组成成分及数量的相关性。方法回顾性分析安徽医科大学第一附属医院骨科2020年1月至2021年12月行初次TKA的618例患者,其中男性166例,年龄50~81岁,平均(66.94±6.90)岁;女性患者452例,年龄52~81岁,平均(65.90±7.57)岁。根据中华医学会糖尿病分会标准诊断MS。同时依据所达到的MS组成成分个数将所有患者分为5组(0MS组、1MS组、2MS组、3MS组、4MS组)。所有受试者均在术前检测双下肢血管超声以排除术前下肢DVT,术后同样行双下肢血管超声检查筛查DVT。同时行临床体征检查并记录TKA后的症状性DVT事件。采用单因素分析和多因素logistic回归分析明确MS及其组成成分和数量与术后总DVT及症状性DVT发病率的相关性。结果618例行TKA患者中,术后出现DVT患者260例,占比42.10%,症状性DVT患者49例,占比7.93%。TKA术后,血脂异常与总DVT[95%CI(1.492~3.310),P<0.001]及症状性DVT[95%CI(2.192~15.232),P<0.001]均相关。身体质量指数(body mass index,BMI)≥25 kg/m 2与总DVT[95%CI(0.371~0.801),P=0.027]有关,与症状性DVT[95%CI(0.623~4.777),P=0.074]无关,代谢综合征与总DVT[95%CI(2.221~7.384),P=0.042]有关,与症状性DVT[95%CI(1.036~12.575),P=0.077]无关。结论(1)MS患者在TKA术后总DVT发病率的风险增加。MS组成成分中血脂异常是TKA术后总DVT及症状性DVT发生的独立风险因素;超重(BMI≥25 kg/m 2)是TKA术后总DVT发生的独立风险因素。(2)TKA患者术后总DVT及症状性DVT的发病率和MS组成成分数量有关。MS组成成分数量越多,术后总DVT及症状性DVT的发病率越高。

Objective To study the correlation between the incidence of total deep vein thrombosis(DVT)and symptomatic DVT after total knee arthroplasty(TKA)and each component and quantity of the metabolic syndrome(MS).Methods 618 patients who underwent initial TKA in our department from January 2020 to December 2021 were retrospectively analyzed.MS was diagnosed according to the criteria of the Diabetes Branch of Chinese Medical Association.There were 166 male patients aged 50~81 years,with an average age of(66.94±6.90)years and 452 female patients aged 52~81 years,with an average age of(65.90±7.57)years.All patients were also divided into five groups(0MS factor group,1MS factor group,2MS factor group,3MS factor group,and 4MS factor group)based on the number of MS components achieved.All subjects underwent preoperative bilateral lower extremity vascular ultrasound to rule out preoperative lower extremity DVT,and postoperative bilateral lower extremity vascular ultrasound to screen for DVT.Clinical signs were also examined and symptomatic DVT events after TKA were recorded.Univariate and multifactorial logistic regression analyses were used to clarify the correlation between MS and its components and quantities with the incidence of total and symptomatic postoperative DVT.Results 618 patients undergoing TKA were included in this study.260 patients(42.10%)had DVT after surgeries and 49 patients(7.93%)had symptomatic DVT.In total knee arthroplasty,dyslipidemia was related with both the incidence rate of total DVT[95%CI(1.492~3.310),P<0.001]and symptomatic DVT[95%CI(2.192~15.232),P<0.001].Body mass index(BMI)≥25 kg/m 2 was related with total DVT[95%CI(0.371~0.801),P=0.027]was related with the incidence rate of total DVT[95%CI(0.623~4.777),P=0.074]and metabolic syndrome was related with the incidence rate of total DVT[95%CI(2.221~7.384),P=0.042]and not related with symptomatic DVT[95%CI(1.036~12.575),P=0.077].Conclusion Patients with MS have increased risk of the incidence rate of total DVT after total knee arthroplasty.Dyslipidemia in the MS component is an independent risk factor for the incidence rate of total DVT and symptomatic DVT after total knee arthroplasty,and overweight(BMI≥25 kg/m 2)is an independent risk factor for the incidence rate of total DVT after total knee arthroplasty.The incidence rate of total DVT and symptomatic DVT after total knee arthroplasty is related to the number of MS components;the higher the number of MS components,the higher the incidence rate of total DVT and symptomatic DVT after surgery.