住院风湿病患者骨密度变化及应用FRAX评估其骨折危险性的研究

Evaluation of bone mineral density by DXA and fracture risk using FRAX in patients with rheumatism

目的观察风湿病患者骨密度(BMD)的变化以及FRAX评估患者10年内发生骨折的概率情况。方法选取风湿科住院患者156例。健康对照组:168例。分别检测股骨颈、腰椎(L1-L4)的BMD并应用FRAX计算10年内发生髋部骨折(BHF)和主要部位骨质疏松性骨折(BMO)的概率;其中风湿病组中95例患者检测血清CRP、Ca2+、P3-、ALP、ESR、骨代谢标志物(甲状旁腺激素、血清25羟维生素D、Ⅰ型胶原羧基端交联肽、骨钙素、β-胶原特殊序列)的水平。结果 1风湿病组患者10年内发生BHF(2.859±6.299)%和BMO的概率(9.485±10.006)%明显高于健康对照组(0.127±0.285)%、(3.910±1.741)%,差异有统计学意义(P<0.05)。2风湿病组中系统病变组BHF(1.742±3.406)%和BMO(7.607±6.580)%低于关节病变组(4.508±8.795,12.25±13.152)%,差异有统计学意义(P<0.05)。3风湿病组BHF和BMO与ALP、ESR、TP1NP、骨钙素、病程呈正相关性。4采用和不采用股骨颈BMD值计算BHF和BMO差异无统计学意义(P>0.05)。5风湿病组中达到WHO建议治疗阈值BHF≥3%有34例,占总人数的21.8%;BMO≥20%有14例,占总人数的9.0%。健康对照组中无一例BHF≥3%或BMO≥20%。结论风湿病患者存在不同程度的BMD降低,FRAX测评结果显示风湿病患者10年内发生髋部骨折和主要部位骨质疏松性骨折危险性明显增加,应引起医生与患者的重视,采取积极防治措施。

Objective To observe the bone mineral density（ BMD） and evaluate the probability of bone fracture in 10 years using FRAX in patients with rheumatism. Me thods One hundred and fifty-six in-patients with rheumatism and one hundred and sixtyeight normal controlls were enrolled in this study. Rheumatic patients were divided into systemic disease group and joint disease group according to their main clinical manifestations. BMD and T- value of the 1umbar vertebrae（ L1-L4）and the femoral neck in both groups were detected. Evaluation of the risk of hip fracture（ BHF） and major osteoporotic（ BMO） fracture in 10 years using FRAX.CRP,ESR,Ca^2 ＋,P^3-,ALP and bone metabolic markers（ PTH、25-（ OH） VD3、TP1NP、BGP、β-Crosslaps） of patients in rheumatism group（ n = 95） were detected. Re sults The probability of hip fractures and osteoporotic fractures in 10 years in rheumatism group were 2. 859 ± 6. 299% and 9. 485 ± 10. 006%,respectively,which was significantly higher than that in control group（ 0. 127 ±0. 285% and 3. 910 ± 1. 741%,P〈0. 05）. The probability of hip fractures and osteoporotic fractures in 10 years in systemic disease group were 1. 742 ± 3. 406% and7. 607 ± 6. 580% which were lower than that in joint disease group（ 4. 508 ± 8. 795% and 12. 25 ±13. 152%,P〈0. 05）. The probability of hip fractures and osteoporotic fractures in 10 years in rheumatic patients were positively correlated with ALP,ESR,TP1 NP,BGP and disease duration. There is no difference between the results of FRAX calculated with BMD and without BMD. The prevalence of 10-year fracture and osteoporotic fractures risks in rheumatic group exceeded the intervention level recommended by WHO are greatly higher than the normal contral（ P〈0. 05）. Conclusion Osteoporosis and osteopenia are more common in rheumatic disease patients. Evaluation using FRAX shows that the risk of hip fractures and major osteoporotic fractures in 10 years in rheumatic patients is higher than that in normal contral. We should pay more attention for these patients regarding osteoporosis.