FRAX在青海地区不同民族2型糖尿病患者骨折风险评估的临床应用

The clinical application of FRAX in the fracture risk assessment of patients with type 2 diabetes of different ethnic groups in Qinghai

目的探讨骨折风险评估工具(FRAX)对青海地区汉族、回族、藏族2型糖尿病(diabetes mellitus type 2,T2DM)患者骨折风险评估的临床应用价值。方法随机选择2018年12月至2020年10月青海大学附属医院收治的符合纳入与排除标准的研究对象324例,收集所选患者的FRAX中相关骨折危险因素,在FRAX中录入相关指标后计算3组患者未来10年髋部骨折概率(PHF)及主要部位骨折概率(PMOF);根据民族将其分为汉、回、藏3组,比较三民族PMOF及PHF的差异;根据代入与不代入股骨颈骨密度T值分为FRAX(BMD-T)组和FRAX组,比较代入和不代入BMD-T时各民族PMOF及PHF的差异;以股骨颈骨密度T值≤-2.5为干预治疗金标准,运用ROC曲线确定本地区最佳干预阈值。结果①三民族代入和不代入BMD-T时PMOF和PHF差异均有统计学意义(P<0.05)。②三民族PHF在男性人群中差异有统计学意义(P<0.05),女性无差异(P>0.05);而三民族PMOF在男性、女性人群中差异均无统计学意义(P<0.05)。③FRAX预测未来10年PMOF的ROC曲线下面积为0.986(P<0.001),cutoff值为3.80%,PHF的ROC曲线下面积为0.993(P<0.001),cutoff值为2.00%。结论①FRAX中代入BMD-T能更准确评估本地区T2DM患者骨折风险并指导治疗,当PMOF≥3.8%或PHF≥高于2.0%时即需要干预治疗。②三民族男性患者中汉族PHF最高,回族、藏族无差异,PMOF三民族间无差异;女性患者中PHF、PMOF三民族间无差异。

Objective To explore the clinical application value of the fracture risk assessment tool(FRAX)for fracture risk assessment in patients with type 2 diabetes(T2DM)in Han,Hui,and Tibetan nationalities in Qinghai.Methods A total of 324 subjects who meet the inclusion and exclusion criteria in our hospital from December 2018 to October 2020 were randomly selected.The relevant fracture risk factors in FRAX in selected patients were collected.The probability of hip fracture(PHF)and probability of a major osteoporotic fracture(PMOF)in the next 10 years of the three groups of patients were recorded and calculated.According to ethnicity,patients were divided into three groups:Han,Hui,and Tibet.The difference in PMOF and PHF among the three ethnic groups were compared.According to the BMD-T of the femoral neck with or without substitution,patients were divided into FRAX(BMD-T)group and FRAX group.The differences in PMOF and PHF of each ethnic group were compared when BMD-T was substituted with or without BMD-T.With femoral neck BMD-T≤-2.5 as the gold standard for intervention treatment,ROC curve was used to determine the best intervention threshold in the region.Results(1)There were statistical differences in PMOF and PHF among the three ethnic groups with or without BMD-T(P<0.05).(2)PHF among the three ethnic groups was statistically different in men(P<0.05),and there was no difference in women(P>0.05).PMOF of the three groups had no statistical difference between male and female populations(P>0.05).(3)FRAX predicted that the area under the ROC curve of PMOF in the next 10 years was 0.986(P<0.001),and the cutoff value was 3.80%.The area under the ROC curve of PHF was 0.993(P<0.001),and the cutoff value was 2.00%.Conclusion(1)Substituting BMD-T in FRAX can more accurately assess the fracture risk of T2DM patients in the region and guide the treatment.Intervention and treatment are required when PMOF≥3.8%or PHF≥2.0%.(2)Among the male patients of the three nationalities,Han nationality has the highest PHF.There is no difference in PHF between Hui and Tibetan nationality.There is no difference in PMOF among the three nationalities.There is no difference in PHF and PMOF among female patients of the three nationalities.