Musowoya Raymond Mpanjilwa, Kaonga Patrick, Bwanga Alick, Chunda-Lyoka Catherine, Lavy Christopher, Munthali James
Department of Surgery, University Teaching Hospital, Lusaka, Zambia.
Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia.
Bone Jt Open. 2020 Jun 2;1(6):175-181. doi: 10.1302/2633-1462.16.BJO-2020-0013.R1. eCollection 2020 Jun.
Sickle cell disease (SCD) is an autosomal recessive inherited condition that presents with a number of clinical manifestations that include musculoskeletal manifestations (MM). MM may present differently in different individuals and settings and the predictors are not well known. Herein, we aimed at determining the predictors of MM in patients with SCD at the University Teaching Hospital, Lusaka, Zambia.
An unmatched case-control study was conducted between January and May 2019 in children below the age of 16 years. In all, 57 cases and 114 controls were obtained by systematic sampling method. A structured questionnaire was used to collect data. The different MM were identified, staged, and classified according to the Standard Orthopaedic Classification Systems using radiological and laboratory investigations. The data was entered in Epidata version 3.1 and exported to STATA 15 for analysis. Multiple logistic regression was used to determine predictors and predictive margins were used to determine the probability of MM.
The cases were older median age 9.5 (interquartile range (IQR) 7 to 12) years compared to controls 7 (IQR 4 to 11) years; p = 0.003. After multivariate logistic regression, increase in age (adjusted odds ratio (AOR) = 1.2, 95% confidence interval (CI) 1.04 to 1.45; p = 0.043), increase in the frequency of vaso-occlusive crisis (VOC) (AOR = 1.3, 95% CI 1.09 to 1.52; p = 0.009) and increase in percentage of haemoglobin S (HbS) (AOR = 1.18, 95% CI 1.09 to 1.29; p < 0.001) were significant predictors of MM. Predictive margins showed that for a 16-year-old the average probability of having MM would be 51 percentage points higher than that of a two-year-old.
Increase in age, frequency of VOC, and an increase in the percentage of HbS were significant predictors of MM. These predictors maybe useful to clinicians in determining children who are at risk.Cite this article: 2020;1-6:175-181.
镰状细胞病（SCD）是一种常染色体隐性遗传病，有多种临床表现，包括肌肉骨骼表现（MM）。MM在不同个体和环境中的表现可能不同，其预测因素尚不明确。在此，我们旨在确定赞比亚卢萨卡大学教学医院SCD患者中MM的预测因素。
2019年1月至5月，对16岁以下儿童进行了一项非匹配病例对照研究。通过系统抽样方法共获得57例病例和114例对照。使用结构化问卷收集数据。根据标准骨科分类系统，通过影像学和实验室检查对不同的MM进行识别、分期和分类。数据录入Epidata 3.1版本并导出到STATA 15进行分析。采用多元逻辑回归确定预测因素，并使用预测边际来确定MM的概率。
病例组的中位年龄为9.5岁（四分位间距（IQR）为7至12岁），高于对照组的7岁（IQR为4至11岁）；p = 0.003。多因素逻辑回归分析后，年龄增加（调整优势比（AOR）= 1.2，95%置信区间（CI）为1.04至1.45；p = 0.043）、血管闭塞性危机（VOC）频率增加（AOR = 1.3，95%CI为1.09至1.52；p = 0.009）以及血红蛋白S（HbS）百分比增加（AOR = 1.18，95%CI为1.09至1.29；p < 0.001）是MM的显著预测因素。预测边际显示，对于一名16岁儿童，患MM的平均概率比一名2岁儿童高51个百分点。
年龄增加、VOC频率增加以及HbS百分比增加是MM的显著预测因素。这些预测因素可能有助于临床医生确定有风险的儿童。引用本文：2020；1 - 6：175 - 181。
