绝经后女性类风湿关节炎患者骨折风险评估工具的预测价值  

Clinical application of fracture risk assessment tool to predicting the osteoporotic fractures in postmenopausal women with rheumatoid arthritis

作　　者：盛君[1] 陆进明[1] 强孚勇[1] 毛桐俊[1] 

机构地区：[1]皖南医学院第一附属医院弋矶山医院风湿免疫科,安徽芜湖241001

出　　处：《皖南医学院学报》2016年第3期226-229,共4页Journal of Wannan Medical College

基　　金：皖南医学院弋矶山医院三新项目(Y12032)

摘　　要：目的：应用世界卫生组织骨折风险评估工具（FRAX）对绝经后女性类风湿关节炎（RA）患者骨质疏松性骨折风险进行评估。方法：收集2012~2013年门诊及住院的119例绝经女性RA患者的相关临床资料及实验室指标,使用美国GE-lunar双能X线骨密度仪对患者的腰椎及左侧股骨颈的骨矿含量（BMD）进行测定,应用FRAX中国模式计算受试患者未来10年髋部骨折风险概率,采用SPSS 16.0软件对结果进行分析比较。结果：119例RA患者中,年龄39~82岁,平均（58±15）岁,病程2个月~40年,中位数病程7年。骨量减少患者68例（57.1%）,骨质疏松患者32例（26.9%）,自发性髋部骨折患者8例（6.7%）;依据FRAX计算出未来10年髋部骨折概率0.1%~22%,按骨折风险概率分组,高危组与低危组的年龄、体质量指数、血清白蛋白水平及骨密度值相比,差异有统计学意义（P〈0.05）,在病程、绝经年龄、DAS28评分、ESR、CRP、RF、抗CCP抗体方面比较差异无统计学意义（P〉0.05）。线性相关分析显示：髋部骨质疏松性骨折风险概率与年龄、服用激素呈正相关关系,与体质量指数、骨密度呈负相关关系。Logistic回归分析显示：年龄大[OR=1.140,P=0.000,95%CI（1.019,1.193）]、体质量指数低[OR=0.201,P=0.006,95%CI（0.064,0.633）],服用糖皮质激素[OR=4.941,P=0.002,95%CI（1.770,13.796）]及股骨颈骨密度值低[OR=0.927,P=0.005,95%CI（0.867,0.986）]的患者发生髋部10年骨质疏松性骨折风险率增加。结论：年龄大、体质量指数低,服用激素及股骨颈骨密度值低的患者发生髋部10年骨质疏松性骨折风险率增加。由于FRAX应用中未包括RA疾病状态和病程长短,提示FRAX尚不能全面评估绝经女性RA患者骨质疏松性骨折风险。Objective： To assess the clinical value of Fracture Risk Assessment Tool（ FRAX） recommended by World Health Organization（ WHO） in predicting the risks of osteoporotic fractures in postmenopausal women with rheumatoid arthritis（ RA）. Methods： Clinical data and laboratory findings were obtained from 119 postmenopausal women with RA treated in our hospital on outpatient or inpatient basis between January 2012 and December 2013. All patients were measured for the bone mineral density（ BMD） at the lumbar vertebra and left femoral neck with Dual-energy X-ray absorptiometry（ DXA,GE Lunar Prodigy,US）,and computed for the fracture risks at the hip in the following 10 years with FRAX model for Chinese women,by which patients were allocated to high risk and low risk group. Software SPSS（ version 16. 0） was used to analyze the results. Results： In 119 RA women,the ages ranged from39 to 82 years,with average age of（ 58 ± 15） years. Disease course was from 2 months to 40 years（ mean 7 years）. Reduced bone volume was seen in 68cases（ 57. 1%）,osteoporosis in 32（ 26. 9%） and spontaneous hip fracture in 8（ 6. 7%）. By FRAX screens,risks for hip fractures in the following decade were 0. 1% to 22% in our cohort. The difference was significant between high and low risk groups regarding the ages,BMI,serum albumin level and ratio of bone density（ P〈0. 05）,yet not significant concerning the course of disease,age of menopause,Disease Activity Score-28（ DAS28）,erythrocyte sedimentation rate（ ESR）,C-reactive protein（ CRP）,rheumatoid factor（ RF） and antibodies to cyclic citrullinated peptide（ CCP）（ P〈0. 05）. Linear correlation analysis indicated that risks for hip fractures from osteoporosis were positively related to patient＇s age and history of oral glucocorticoid,yet negatively to BMI and bone density. Logistic regression analysis demonstrated higher risks for osteoporotic hip fractures in following decade in women of older age[OR= 1. 140,P〈0. 001; 95%

关 键 词：类风湿关节炎 骨质疏松 骨折风险评估工具(FRAX) 绝经女性 

分 类 号：R593.22[医药卫生—内科学] R683[医药卫生—临床医学]