多中心风湿病患者应用骨折风险评估模型评估骨折风险的临床分析

Clinical analysis of FRAX in the assessment of fracture risk in patients with rheumatic disease in three medical center

目的使用世界卫生组织(WHO)推荐的骨折风险评估模型(FRAX)评估风湿病患者骨折风险,以便早期预防风湿病患者骨质疏松性骨折的发生.方法收集2018年3至10月解放军总医院第四医学中心风湿科、中日友好医院风湿免疫科和积水潭医院风湿免疫科病例,共617例.617例中门诊风湿病组204例,住院风湿病组204例,健康对照组209例,比较3组间未来10年髋部骨折概率(PHF)和主要部位骨质疏松性骨折概率(PMOF),比较服用与不服用糖皮质激素风湿病患者骨折概率的差异以及使用FRAX评估骨折风险时采用或不采用股骨颈骨密度值之间的差异,同时对住院风湿病患者的PHF、PMOF与年龄、病程、性别、是否服用糖皮质激素、骨钙素、1型原胶原N-端前肽(PlNP)及β-胶原特殊序列(β-Crosslaps)进行相关性分析.结果门诊风湿病组、住院风湿病组及健康对照组10年内发生PMOF分别是3.455±2.690、2.973±2.149及3.323±1.828,3组之间比较差异无统计学意义(P>0.05),而PHF分别是0.986±1.619、0.515±0.873及0.149±0.311,3组间差异有统计学意义(P<0.05);随着年龄增大,PHF和PMOF逐渐增高;服用糖皮质激素风湿病患者的PMOF较未服用糖皮质激素者高(3.554±2.584比2.857±2.238,P<0.05);风湿病患者使用FRAX评估PHF和PMOF时采用或不采用股骨颈骨密度值间差异无统计学意义(3.012±2.231比3.207±2.601,P>0.05);住院风湿病患者PHF及PMOF与年龄、病程、服用糖皮质激素及骨钙素水平呈正相关,而PHF与P1NP呈负相关.结论风湿病患者较健康对照者未来10年PHF高,有更多的危险因素;服用糖皮质激素的风湿病患者PMOF升高;如无条件筛查股骨颈骨密度值,可直接使用FRAX评估骨折风险,同时可结合骨转换标记物,及时筛查和防治风湿病患者的骨质疏松性骨折.

Objective The aim is to analyze the fracture risk in rheumatic patients by fracture risk assessment tool(FRAX),which is recommended by World Health Organization(WHO),so that we can prevent the occurrence of osteoporotic fracture earlier.Methods Totally 617 participants,204 out-patients with rheumatism,204 in-patients with rheumatism and 209 healthy controls,from March to October in 2018 of Fourth Medical Center of PLA General Hospital,Jishuitan Hospital and China-Japan Friendship Hospital,were enrolled in this study.The probability of hip fracture(PHF)and major osteoporotic fracture(PMOF)in 10 years with FRAX were compared,and the differences between taking sleroids or not and with or without bone mass density(BMD)of femoral neck were evaluated.Correlation analysis was conducted between PHF,PMOF and clinical information,including age,disease duration,gender,steroid usage,osteocalcin,P1NP andβ-crosslaps.Results There was no significant difference in PMOF within 10 years(3.455±2.690 vs 2.973±2.149 vs 3.323±1.828)among the three groups(P>0.05),but the PHF(0.986±1.619 vs 0.515±0.873 vs 0.149±0.311)was different(P<0.05).PHF and PMOF increased gradually with age.PMOF of patients without glucocorticoid therapy in 10 years was lower than that of patients with glucocorticoid(3.554±2.584 vs 2.857±2.238,P<0.05).There is no difference between the results of FRAX calculated with BMD or not(3.012±2.231 vs 3.207±2.601,P>0.05).PHF and PMOF were positively correlated with age,course of disease,glucocorticoid use and osteocalcin level,while PHF was negatively correlated with TP1NP among in-patients.Conclusion The prevalence of 10-year hip fracture calculated by FRAX in rheumatism patients is higher than that of healthy group.FRAX can be used to calculate fracture risk without BMD.Combination of FRAX and bone turnover markers may be more effective in prediction of osteoporotic fracture in rheumatic patients.