药物防治糖皮质激素性骨质疏松的规范性及影响因素分析  

Analysis of the standardization and influential factors in the prevention and treatment of glucocorticoid-induced osteoporosis with drugs

作　　者：蒋文硕 刘琛[1] 曾艳[1] JIANG Wenshuo;LIU Chen;ZENG Yan(Dept.of Pharmacy,Xuanwu Hospital of Capital Medical University,Beijing 100037,China;College of Pharmacy,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学宣武医院药学部,北京100037 [2]首都医科大学药学院,北京100069

出　　处：《中国药房》2025年第8期991-995,共5页China Pharmacy

基　　金：医疗质量(循证)管理研究项目(No.YLZLXZ24-K010)。

摘　　要：目的分析糖皮质激素性骨质疏松(GIOP)防治药物使用的规范性和影响因素。方法回顾性收集2022年1月1日至2023年12月31日于我院诊断为风湿免疫性疾病的需长期使用糖皮质激素的住院患者资料。分析患者的GIOP骨折风险分层及防治药物使用情况;采用单因素分析和Logistic逐步回归分析筛选影响患者防治药物使用规范性的因素。结果354例患者中,148例患者(41.81%)的骨折风险为低度,103例患者(29.10%)为中度,103例患者(29.10%)为高度;GIOP防治药物使用排名前3位的分别为钙剂(78.81%)、维生素D制剂(74.01%)、抗骨质疏松药物(21.19%)。133例(37.57%)患者规范使用了GIOP防治药物,低度骨折风险患者的防治规范率显著高于高度和中度骨折风险患者,且高度骨折风险患者显著高于中度骨折风险患者(P<0.05)。单因素分析结果显示,低度骨折风险是GIOP防治药物使用规范性的保护因素,中度骨折风险、吸烟或饮酒、出现药物不良反应以及大专以下文化程度是其危险因素(P<0.05)。Logistic逐步回归分析结果显示,有低、中度骨折风险,有吸烟或饮酒史,服用抗骨质疏松药物后出现不良反应患者的防治规范率较低,而既往1个月就诊三甲医院、使用糖皮质激素时间更长患者的防治规范率较高(P<0.05)。结论我院GIOP防治药物的使用规范率较低;中、高度骨折风险,吸烟或饮酒史,服用抗骨质疏松药物后出现不良反应患者的防治规范率较低,而既往1个月就诊于三甲医院、使用糖皮质激素时间更长患者的防治规范率较高。OBJECTIVE To analyze the standardization and influential factors medication use for the prevention and treatment of glucocorticoid-induced osteoporosis(GIOP).METHODS The data of inpatients diagnosed as rheumatic immune diseases in our hospital from January 1,2022,to December 31,2023,who required long-term use of glucocorticoids,were collected to analyze the risk stratification for GIOP-related fractures and the utilization of prevention and treatment drug in patients.Univariate analysis and Logistic stepwise regression analysis were employed to screen the factors influencing the standardization of prevention and treatment drug use in patients.RESULTS Among 354 patients,148 patients(41.81%)had a low risk of osteoporotic fractures,103 patients(29.10%)had a moderate risk,and 103 patients(29.10%)had a high risk.The top three drugs used in the prevention and treatment of GIOP were calcium supplements(78.81%),vitamin D preparations(74.01%),and anti-osteoporosis drugs(21.19%).A total of 133 patients(37.57%)used the drugs for GIOP prevention and treatment in a standardized manner.The standardization rate of prevention and treatment in patients with low fracture risk was significantly higher than those with high and moderate fracture risk,and the standardization rate in patients with high fracture risk was significantly higher than those with moderate fracture risk(P<0.05).Besides,the univariate analysis showed that low fracture risk served as a prevention factor for the standardized use of prevention and treatment drugs for GIOP,while moderate fracture risk,smoking or drinking,the occurrence of adverse drug reactions,and having an educational level below junior college were risk factors for the normative use of GIOP prevention and treatment drug(P<0.05).Logistic stepwise regression analysis showed that patients with low and moderate fracture risk,a history of smoking or drinking,and adverse drug reactions to anti-osteoporosis drugs had a lower standardization rate of prevention and treatment;patients who visited tertiary

关 键 词：糖皮质激素 骨质疏松 骨折风险 药物防治 影响因素 

分 类 号：R977.11[医药卫生—药品]