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| 校正FRAX在2型糖尿病中的干预阈值及应用价值 |
| Intervention threshold and application value of corrected FRAX in type 2 diabetes |
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| DOI：10.3969/j.issn.1006-7108.2023.06.013 |
| 中文关键词: FRAX 糖尿病 骨折风险 骨密度 骨质疏松症 |
| 英文关键词:FRAX diabetes mellitus risk of fracture bone mineral density osteoporosis |
| 基金项目:自治区科技支疆项目（2020E0281）；新疆维吾尔自治区人民医院院内项目（20200105） |
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| 中文摘要: |
| 的 确定2型糖尿病（T2DM）患者使用类风湿关节炎（RA）校正FRAX的干预阈值，并验证、评估其预测的价值。方法 选择符合纳入标准的508名T2DM患者，收集其临床资料，测量DXA骨密度，使用T2DM代替 FRAX 中RA选项在无BMD模式下行FRAX评分，根据骨质疏松症（OP）诊断标准将患者分为骨质疏松组和非骨质疏松组，比较其临床资料、BMD及校正FRAX评分的差异。通过 Logistic 回归模型及ROC曲线分析校正FRAX的预测效力。通过分析校正FRAX辅助诊断OP的灵敏度和特异度确定校正FRAX的干预阈值，并通过2年随访进一步验证其临床应用价值。结果 OP组女性比例、有既往骨折史、使用糖皮质激素、有继发性骨质疏松及校正FRAX-MOF 、校正FRAX-HF均高于非OP组；OP组L1~4、股骨颈、髋部BMD（g/cm2）、身高、体重均低于非OP组（P均＜0.05）。校正FRAX-MOF 、校正FRAX-HF均为骨质疏松症的独立危险因素，ROC曲线下面积为AUC：0.813&0.719，P均＜0.05。以校正FRAX-MOF≥4%或FRAX-HF≥1%为校正FRAX干预阈值：Se 0.825、Sp 0.538、PPV 0.612、NPV 0.637 、Kappa值0.636。2年随访期间16名患者发生骨折事件，骨折患者女性比例、年龄、糖尿病病程、糖尿病病程≥12年、股骨颈BMD（g/cm2）、全髋BMD（g/cm2）、校正FRAX-MOF（%）、校正FRAX-HF（%）、校正FRAX-MOF≥4或校正FRAX-HF≥1人数高于未骨折患者（P均＜0.05）。骨折患者中超过校正FRAX-新干预及旧干预阈值人数分别为12人、3人（P＜0.001）。校正FRAX-新干预阈值或女性、校正FRAX-新干预阈值或糖尿病病程≥12年时灵敏度为87.5%（最高），校正FRAX-新干预阈值且糖尿病病程≥12年时特异度为84.3%（最高）。结论 RA校正FRAX对T2DM患者骨折风险评估具有良好的应用价值，以校正FRAX-MOF≥4%或FRAX-HF≥1%作为干预阈值具有较高准确性，且并联女性、糖尿病病程或串联糖尿病病程风险因素可进一步提高灵敏度、特异度，值得进一步推广。 |
| 英文摘要: |
| Objective To determine the intervention threshold of FRAX adjusted for rheumatoid arthritis (RA) in patients with type 2 diabetes mellitus (T2DM), and to verify and evaluate its predictive value. Methods A total of 508 T2DM patients who met the inclusion criteria were selected, their clinical data were collected, DXA bone mineral density (BMD) was measured, and T2DM was replaced by RA option in FRAX under the non-BMD mode. The FRAX score was calculated. The clinical data, BMD and corrected FRAX scores were compared between the two groups. The predictive power of FRAX was corrected by Logistic regression model and ROC curve analysis. The sensitivity and specificity of corrected FRAX in assisting the diagnosis of OP were analyzed to determine the intervention threshold of corrected FRAX, and its clinical application value was further verified through a 2-year follow-up. Results Compared with the non-OP group, the OP group had a higher proportion of females, a history of previous fracture, glucocorticoid use, secondary osteoporosis, corrected FRAX-MOF, and corrected FRAX-HF. BMD (g/cm2) of L1-4, femoral neck, and hip, height, and weight in OP group were lower than those in non-OP group (all P<0.05). Adjusted FRAX-MOF and adjusted FRAX-HF were independent risk factors for osteoporosis, and the area under the ROC curve was AUC: 0.813&0.719 (P<0.05). The adjusted FRAX intervention thresholds were Se 0.825, Sp 0.538, PPV 0.612, NPV 0.637, and Kappa 0.636 when the corrected FRAX-MOF≥4% or FRAX-HF≥1%. During 2 years of follow-up, 16 fractures occurred. The proportion of women, age, duration of diabetes, duration of diabetes ≥12 years, BMD of femoral neck (g/cm2), BMD of total hip (g/cm2), adjusted FRAX-MOF (%), adjusted FRAX-HF (%), adjusted FRAX-MOF≥4 or adjusted FRAX-HF≥1 were higher in patients with fractures than in those without fractures (all P<0.05). The number of fracture patients exceeding the adjusted FRAX-new intervention threshold and the old intervention threshold was 12 and 3, respectively (P<0.001). The sensitivity of FRAX-adjusted threshold for new intervention or female gender, adjusted FRAX-adjusted threshold for new intervention or duration of diabetes≥12 years was 87.5% (highest), and the specificity of FRAX-adjusted threshold for new intervention and duration of diabetes≥12 years was 84.3% (highest). Conclusions RA adjusted FRAX has a good application value in the risk assessment of fracture in T2DM patients. The sensitivity and specificity can be further improved by adjusting FRAX-MOF≥4% or FRAX-HF≥1% as the intervention threshold. |
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