系统应用糖皮质激素患者的FRAX骨折风险评估分析  

Analysis of FRAX fracture risk assessment in patients with systemic glucocorticoid therapy

作　　者：徐鹏慧 张清 孔祥艳 叶彬 楚燕芳 卢敏辉 屈文龙 周惠琼 XU Penghui;ZHANG Qing;KONG Xiangyan;YE Bin;CHU Yanfang;LU Minhui;QU Wenlong;ZHOU Huiqiong(Department of Rheumatology, The Fourth medical centre, Chinese PLA General Hospital, Beijing 100048;Department of Graduate, Medical School of Chinese PLA, Beijing 100853)

机构地区：[1]中国人民解放军总医院第四医学中心风湿科,北京100048 [2]解放军总医院研究生院,北京100853

出　　处：《中国骨质疏松杂志》2020年第12期1768-1772,共5页Chinese Journal of Osteoporosis

摘　　要：目的通过使用糖皮质激素(glucocorticoid,GC)校正的骨折危险性评估工具(fracture risk assessment tool,FRAX),评估系统应用GC对风湿病患者群体骨折风险的影响。方法纳入2019年1月至2020年1月于解放军总医院第四医学中心就诊且行髋部和腰椎骨密度检测的风湿病患者180例和同期健康体检者180例,风湿病患者均系统性使用GC治疗超过3个月,按照日均GC剂量(等同于醋酸泼尼松)分为GC≤7.5 mg组,7.5 mg<GC<30 mg组和≥30 mg组,并对剂量超过7.5 mg的两组进行骨折风险校正,使用FRAX评估系统评估未来10年主要骨质疏松性骨折(PMOF)和髋部骨折(PHF)发生概率,并比较组间的差异。结果①激素使用组PMOF和PHF高于健康对照组,且差异有统计学意义(P<0.05);②按GC使用时间分为>2年组和≤2年组,GC使用>2年组PMOF和PHF均高于≤2年组,且差异有统计学意义;③FRAX校正前GC≤7.5 mg组的PMOF与PHF高于另外两组,差异有统计学意义;④FRAX校正后GC≤7.5 mg组PMOF与PHF仍高于另外两组,与GC≥30 mg组相比差异有统计学意义;⑤按骨质疏松治疗阈值PMOF 20%、PHF 3%计算,激素使用组达到PMOF和PHF治疗阈值者分别为0例和9例(5%);按2017年GIOP推荐的骨质疏松治疗阈值PMOF 10%、PHF 1%计算,达治疗阈值者分别为8例(4.44%)和41例(22.78%)。结论经GC校正后可提高基于FRAX计算出的风湿病患者的骨折风险,且校正后增加了达到骨质疏松治疗阈值的人数,能更有效的预测使用GC的风湿病群体骨折概率,尽早实施预防骨质疏松,从而降低骨折概率。Objective To evaluate the impact of GC on the risk of fracture in rheumatisants by using the fracture risk assessment tool(FRAX)adjusted by Glucocorticoid(GC).Methods 180 patients with rheumatism who had been treated in the Fourth medical centre of PLA General Hospital from January 2019 to January 2020 and 180 healthy people in the same period were enrolled,all of them were measured for bone mineral density tests at hip and lumbar spine.All patients with rheumatism were systematically treated with GC for more than 3 months.According to the daily average dose of GC,they were divided into GC≤7.5 mg group,7.5 mg<GC<30 mg group and≥30 mg group.Then 10 year probability of hip fracture(PHF)and major osteoporotic fracture(PMOF)was calculated by FRAX of Chinese model.For people receiving GC dose of>7.5 mg/d,the fracture risk calculated with FRAX should be adjusted.All result between the groups were compared.Results①PMOF and PHF in GC use group were higher than those in healthy control group,and the difference was statistically significant(P<0.05);②According to the duration of GC usage,they were divided into>2 years group and≤2 years group,and the PMOF and PHF in GC use>2 year group were higher than≤2 years group,the difference was statistically significant;③PMOF and PHF in GC≤7.5 mg group before FRAX adjusted were higher than those in other two groups,and the difference was statistically significant;④PMOF and PHF in GC≤7.5 mg group after FRAX adjusted were still higher than those in other two groups,and the difference was statistically significant compared with GC≥30 mg group;⑤According to the osteoporosis intervention threshold of PMOF 20%and PHF 3%,the patients who reached the treatment threshold were 0 and 9(5%)respectively;according to the intervention threshold of PMOF 10%and PHF 1%which were recommended by GIOP in 2017,the number of patients who reached were 8(4.44%)and 41(22.78%)respectively.Conclusion After GC adjusted,the fracture risk of rheumatism patients who received GC treatment eval

关 键 词：风湿病 糖皮质激素 校正 骨折危险性评估工具 骨折 

分 类 号：R593.2[医药卫生—内科学]