Analysis of influencing factors of fear of falling in patients with knee osteoarthritis and construction of nomogram model北大核心

BACKGROUND: Fear of falling will aggravate the instability of the knee joint in patients with knee osteoarthritis, leading to the reduction of activities and the decline of the overall body function. Therefore, screening the factors affecting the fear of falling in patients with knee osteoarthritis and constructing a nomogram model can reduce the injury caused by the fear of falling and provide a reference for the formulation of individualized diagnosis and treatment plans. OBJECTIVE: To explore the influencing factors and conditions of fear of falling in patients with knee osteoarthritis, and to establish a predictive model for the risk of fear of falling in patients with knee osteoarthritis. METHODS: A cross-sectional study method was used to enroll 560 patients with knee osteoarthritis who visited Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from September 2019 to February 2021. Among them, 469 were in the falling fear group and 91 were in the non-falling fear group. The general information of patients, the Western Ontario and McMaster Universities Arthritis Index, and the Hospital Anxiety and Depression Scale scores were analyzed and compared between the two groups to determine the influencing factors of the fear of falling in knee osteoarthritis patients. Receiver operating characteristic curves of the influencing factors were drawn to obtain the Youden’s index with diagnostic value for the fear of falling. The maximum value of the Youden index of each factor was the best diagnostic value (cutoff value) of the knee osteoarthritis fear of falling. A nomogram was drawn to establish the knee predictive model for the fear of falling in patients with knee osteoarthritis. RESULTS AND CONCLUSION: (1) Logistic regression analysis showed that height and male were the protective factors for the fear of falling in patients with knee osteoarthritis, and age, unemployment, Western Ontario and McMaster Universities Arthritis Index stiffness scale score, and anxiety scale score were the risk factors for the fear of falling in patients with knee osteoarthritis. (2) Receiver operating characteristic curve results showed that Western Ontario and McMaster Universities Arthritis Index had a significant diagnostic value for knee osteoarthritis patients (Youden’s index=0.733), followed by age, anxiety, and gender. (3) The results of the nomogram showed that the maximum score of the Western Ontario and McMaster Universities Arthritis Index stiffness scale (8 points) could account for 41.6% of the predictors of knee osteoarthritis fear of falling. (4) It is concluded that there is a high incidence of fear of falling among patients with knee osteoarthritis, and joint stiffness and female gender may be risk factors for fear of falling, while low height may be a protective factor for fear of falling, and there is a need to focus on fear of falling and the management of related factors in clinical treatment interventions. © 2023, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.     

淫羊藿治疗糖皮质激素性骨质疏松症分子机制的网络药理学分析

目的利用网络药理学方法探索淫羊藿治疗糖皮质激素性骨质疏松症(glucocorticoid-induced osteoporosis,GIOP)的分子作用机制。方法运用中药系统药理学数据库与分析平台(TCMSP)筛选淫羊藿的活性成分及相关靶点;运用Gene Cards数据库、OMIM数据库获取GIOP的疾病靶点;通过R语言将药物靶点与GIOP疾病靶点取交集;利用Cytoscape 3.7.0软件构建"淫羊藿-活性成分-GIOP靶点"网络;运用String数据库构建"淫羊藿-GIOP"共同靶点蛋白互作网络;运用R语言进行GO生物功能和KEGG通路富集分析。结果通过筛选获得淫羊藿的23个主要活性成分,一共涉及GIOP相关的65个靶点;槲皮素(quercetin)、山奈酚(kaempferol)、木犀草素(luteolin)和淫羊藿苷(anhydroicaritin)能与10个以上相关靶点连接,是淫羊藿治疗GIOP的主要成分;白细胞介素-6(IL-6)、血管内皮生长因子A(VEGFA)、丝裂原激活蛋白激酶-8(MAPK8)、胱冬酶-3(CASP3)和雌激素受体-1(ESR1)是"淫羊藿-GIOP"共同靶点蛋白互作关系中连接次数最多的5个靶点,为核心靶点基因。结论淫羊藿有可能是通过前列腺癌信号通路、细胞凋亡信号通路、流体剪切应力与动脉粥样硬化信号通路、TNF信号通路和糖尿病并发症中AGE-RAGE信号通路等多个途径发挥治疗GIOP的作用。为后期的药效机制研究提供了新的思路和方向。