未调整和调整后骨折风险预测工具与2型糖尿病患者髋部骨折风险  

Unadjusted and adjusted fracture risk assessment tool and the hip fracture risk in patients with type 2 diabetes

作　　者：孔晓珂 赵志云[1] 孙立昊[1] 赵红燕[1] 王卫庆[1] 刘建民[1] 陶蓓[1] Kong Xiaoke;Zhao Zhiyun;Sun Lihao;Zhao Hongyan;Wang Weiqing;Liu Jianmin;Tao Bei(National Clinical Research Center for Metabolic Diseases,Shanghai Institute of Endocrine and Metabolic Diseases,Department of Endocrine and Metabolic Diseases,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌代谢病科,上海市内分泌代谢病研究所,国家代谢性疾病临床医学研究中心,200025

出　　处：《中华内分泌代谢杂志》2022年第9期760-765,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：上海市医药卫生发展基金会糖尿病临床研究项目(Ⅱ期06研究)。

摘　　要：目的评估与比较未调整骨折风险预测工具(fracture risk assessment tool,FRAX)及调整后的FRAX在2型糖尿病患者髋部骨折风险预测中的临床价值。方法纳入2009年8月至2013年7月于瑞金医院内分泌代谢病科入院治疗的2型糖尿病患者共1730例,采用FRAX中国模式计算参与者未来10年发生髋部骨折的风险,通过电子医疗系统及电话访谈收集10年随访期间发生的髋部骨折事件。从区分度和校准度两个方面评估FRAX和调整后的FRAX在2型糖尿病患者髋部骨折风险预测中的价值,利用Cox回归模型来研究糖尿病相关因素与髋部骨折之间的关系。结果在中位随访10年期间,39例(2.3%)参与者经历过髋部骨折。未调整FRAX的受试者工作特征曲线下面积为0.760,但校准能力较差[校准χ^(2)为75.78,P<0.001;校准比(观察/预测)为3.97(95%CI 2.76~5.17)],调整后的FRAX校准能力无明显改善。经校正(未调整或调整后FRAX计算出的10年髋部骨折发生概率)后,病程、估算的肾小球滤过率、胰岛素使用、脑血管疾病以及糖尿病周围神经病变均与髋部骨折风险增加显著相关(P<0.05)。结论FRAX工具严重低估了2型糖尿病患者的髋部骨折风险,而调整后的FRAX未能消除病程、周围神经病变等糖尿病相关因素的影响,依然存在着显著低估。Objective To evaluate and compare the clinical value of unadjusted fracture risk assessment tool(FRAX)and adjusted FRAX in predicting the risk of hip fracture in patients with type 2 diabetes(T2DM).Methods In this 10-year retrospective cohort study,1730 patients with T2DM were collected from August 2009 to July 2013.The 10-year risk of hip fracture was calculated using the China FRAX model.Hip fracture events during the follow-up period were collected through electronic medical records and telephone interviews.The value of FRAX and adjusted FRAX in predicting the risk of hip fracture in T2DM patients was evaluated from two aspects of discrimination and calibration.Cox regression model was used to investigate the relationship between diabetes related factors and hip fracture.Results A total of 39 participants(2.3%)experienced hip fracture during a median follow-up of 10 years.The area under the curve of unadjusted FRAX was 0.760,but the calibration ability was poor[calibrationχ^(2):75.78,P<0.001;calibration ratio(observation/prediction):3.97(95%CI 2.76~5.17)].There was no significant improvement in calibration ability of adjusted FRAX.After adjustment for unadjusted or adjusted hip fracture probability calculated by FRAX(FRAX-HF),duration,estimated glomerular filtration rate,insulin use,cerebrovascular diseases,and diabetic peripheral neuropathy were significantly associated with an increased risk of hip fracture(P<0.05).Conclusion The FRAX tool significantly underestimated the risk of hip fracture in T2DM patients,and there was still significantly underestimation after adjustment due to the failure to eliminate the influence of diabetes-related factors such as disease duration and peripheral neuropathy.

关 键 词：骨折风险预测工具 糖尿病 2型 髋部骨折 风险预测 

分 类 号：R587.1[医药卫生—内分泌] R683[医药卫生—内科学]