FRAX评估慢性肾脏病非透析患者骨质疏松性骨折风险研究  

Evaluation of osteoporotic fracture risk by FRAX in non-dialysis patients with chronic kidney disease

作　　者：赵建辉[1] 陈洪宇[2] 姜雪[2] 包自阳[2] 李香茶[2] 

机构地区：[1]新昌县人民医院肾内科,312500 [2]浙江中医药大学附属广兴医院肾内科

出　　处：《浙江医学》2016年第23期1906-1908,1912,共4页Zhejiang Medical Journal

基　　金：2015年新昌县科技计划项目(新科[2015]26号)

摘　　要：目的探讨WHO推荐的骨折风险评估工具(FRAX)用于慢性肾脏病(CKD)3~5期非透析患者骨质疏松性骨折风险评估的临床价值,并分析影响患者骨折风险等级的相关因素。方法 90例CKD患者依据估计的肾小球滤过率(eGFR)分为3组:CKD3期组(35例,eGFR为30~60ml·min^(-1)·1.73m^(-2))、CKD4期组(33例,eGFR为15~30ml·min^(-1)·1.73m^(-2))、CKD5期组(22例,eGFR<15ml·min^(-1)·1.73m^(-2))。应用双能X线吸收法检测患者股骨颈骨密度,记录患者的临床及生化指标,FRAX评估患者骨质疏松性骨折风险等级。结果 3组患者骨质疏松症发生率比较有统计学差异(P<0.05),CKD5期组患者骨质疏松发生率高于CKD3期组(P<0.05)。3组患者骨折风险等级比较有统计学差异(P<0.05)。CKD5期组患者骨折高风险比例高于CKD3期组、CKD4期(均P<0.05)。患者骨折风险等级与骨密度(r=-0.516)、eGFR(r=-0.234)均呈负相关(均P<0.05)。结论 FRAX可用于评估CKD非透析患者的骨质疏松性骨折风险;随着肾功能恶性进展,患者骨质疏松症发生率及骨折风险均呈上升趋势,骨密度是影响患者骨折风险等级的重要因素。Objective To evaluate the risk of osteoporotic fractures in non-dialysis patients with chronic kidney disease by fracture risk assessment tool（FRAX）. Methods Ninety non-dialysis patients with chronic kidney disease were divided into 3groups according to the estimated glomerular filtration rate（eGFR）： CKD stage 3（eGFR, 30 to 60 ml·min^-1·1.73 m^-2）, CKD stage4（eGFR, 15 to 30ml·min^-1·1.73m^-2） and CKD stage 5（eGFR〈15 ml·min^-1·1.73 m^-2）. The femoral neck bone mineral density（BMD） was measured with dual energy X-ray absorptiometry（DEXA）, the risk factors of fractures were surveyed with a questionnaire, the clinical and biochemical indicators were documented. The risk of osteoporotic fractures was assessed with FRAX. Results Compared to those with CKD stage 3, the prevalence of osteoporosis in patients with CKD stage 5 was significantly increased（P〈0.05）. Compared to those with CKD stage 3 and CKD stage 4, the risk of fractures in CKD stage 5patients was significantly increased（P〈0.05）. The fracture risk level was negatively correlated with eGFR and BMD（partial correlation coefficient-0.234 and-0.516, respectively）. Conclusion FRAX can identify the fracture risk in non-dialysis patients with CKD; the CKD stages and bone mineral density are closely correlated with the risk of osteoporotic fractures of patients.

关 键 词：骨折风险评估工具 骨质疏松性骨折 慢性肾脏病 非透析患者 

分 类 号：R692[医药卫生—泌尿科学] R580[医药卫生—外科学] R683[医药卫生—临床医学]