FRAX评估类风湿关节炎患者骨折风险及相关临床危险因素的研究

Study of FRAX to assess fracture risk and associated clinical risk factors in patients with rheumatoid arthritis

目的运用FRAX探究中国RA患者骨折风险及相关临床危险因素。方法纳入52例RA、47例pSS以及41例体检健康者分别为RA组、pSS组、对照组,RA组患者检测ACPA、RF、ESR、CRP并计算DAS28-ESR、HAQ-DI,所有纳入者以双能X线吸收测定法测定骨密度并通过FRAX官方网站预估10年骨折风险。所有统计分析采用SPSS统计软件。结果FRAX相关骨折危险因素包括身高、吸烟、饮酒、既往骨折、父母骨折,在3组间差异未见统计学意义。RA组糖皮质激素累积服用天数高于pSS组(P<0.05)。通过FRAX无论是否结合骨密度评估,RA组主要骨质疏松性骨折风险及髋关节骨折风险均较对照组高(P<0.01),主要骨质疏松性骨折风险亦较pSS组高(P<0.05或P<0.01)。通过FRAX结合骨密度评估,从年龄、糖皮质激素、绝经方面分析,RA组主要骨质疏松性骨折及髋关节骨折风险均较对照组高(P<0.05或P<0.01)。通过FRAX结合BMD评估RA组10年主要骨质疏松性骨折风险发生率分为低危、中危、高危组,ACPA、RF、ESR、CRP、DAS28-ESR、HAQ-DI在三组中均值呈上升趋势,差异均有统计学意义(P<0.01)。结论RA患者骨折风险评估可结合FRAX与骨密度;长期、大量服用糖皮质激素以及高龄、绝经后女性RA患者更应重视骨折风险评估;有效控制RA疾病活动度、改善关节功能情况有助于骨质疏松性骨折的预防。

Objective To investigate fracture risk and related clinical risk factors in RA patients in China by using fracture risk assessment tool(FRAX).Methods Fifty-two cases of rheumatoid arthritis(RA),47 cases of primary Sjogren’s syndrome(pSS),and 41 cases of healthy participants in our hospital were enrolled into RA group,pSS group,and control group,respectively.Patients in RA group were tested for ACPA,RF,ESR and CRP.DAS28-ESR and HAQ-DI were calculated.BMD was accessed with dual energy X-ray absorptiometry.10-Year fracture risk was evaluated with FRAX.The statistical analyses were conducted with a SPSS statistical software.Results In this study,FRAX-related fracture risk factors such as height,smoking,alcohol consumption,previous fracture,and parental fracture were not statistically different among the three groups.The cumulative days of glucocorticoid use in RA group was higher than that in pSS group(P<0.05).The risk of major osteoporotic fractures and hip fractures in the RA group was higher than that in the pSS group(P<0.05 or P<0.01),regardless of whether FRAX combined BMD or not.The risk of major osteoporotic fracture and hip fracture in RA group was higher than that in control group(P<0.05 or P<0.01)in terms of age,glucocorticoid use,and menopause,as assessed with FRAX combined with BMD evaluation.The 10-year risk incidence of major osteoporotic fractures in RA group was assessed with FRAX combined with BMD and divided into low-risk,medium-risk,and high-risk groups.The mean values of ACPA,RF,ESR,CRP,DAS28-ESR,and HAQ-DI showed an upward trend in the three groups,and the differences were statistically significant(P<0.01).Conclusion Fracture risk assessment in RA patients could be performed using FRAX combined with BMD.RA patients with long-term and high-dose use of glucocorticoids,elderly,and post-menopause should pay more attention to the assessment of fracture risk.Effective control of disease activity and improvement of joint function in RA would help to prevent osteoporotic fracture.