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| 应用FRAX评估脊柱关节炎患者骨折风险及危险因素分析 |
| Fracture risk assessment in patients with spondyloarthritis using FRAX and analysis of related risk factors |
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| DOI：10.3969/j.issn.1006-7108.2024.11.005 |
| 中文关键词: 脊柱关节炎 FRAX 骨质疏松症 骨折风险评估 |
| 英文关键词:spondyloarthritis FRAX osteoporosis fracture risk assessment |
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| 中文摘要: |
| 目的 应用骨折风险评估工具（fracture risk assessment tool，FRAX）评估脊柱关节炎（spondyloarthritis，SpA）患者的骨折风险并进行相关危险因素分析，探讨不同FRAX模型检测SpA患者的适用性。方法 纳入130例SpA患者为患者组，选取130例同期健康体检者为对照组，使用FRAX对两组人员进行未来10年主要骨质疏松性骨折（major osteoporotic fracture，MOF）和髋部骨折（hip fracture，HF）发生概率的评估，同时使用改良的不同FRAX模型对患者组进行骨折风险评估并比较它们的异同性。结果 ①患者组不论是否加入骨密度（bone mineral density, BMD），其MOF和HF的风险均高于对照组。在不使用BMD的FRAX评估时，SpA患者的MOF风险为1.57±0.87显著高于对照组的1.36±0.57（P<0.001），HF风险为0.22±0.43显著高于对照组的0.13±0.13（P=0.019）；在加入BMD的FRAX评估时，MOF风险为2.60±5.10显著高于对照组1.37±0.47（P=0.007），HF风险为1.11±4.83显著高于对照组的0.11±0.11（P=0.019）；②去除BMD的FRAX模型评估SpA患者时，是否采用SpA代替类风湿关节炎（rheumatoid arthritis,RA）选项（SpA-FRAX），达干预阈值结果相同，达干预阈值的MOF患者为0例，HF患者为2例（1.5%）。加入BMD的FRAX评估检测效能提高，达干预阈值的MOF为2例（1.5%），HF为9例（6.2%）；采用SpA代替RA选项（SpA-FRAX-BMD）后，MOF检测结果无差别仍为2例（1.5%），HF的检测结果提高为13例（9.2%）；③患者组股骨颈BMD显著低于对照组，有91%的患者25羟基维生素D3低于正常值；④多元回归结果显示，腰椎BMD、血磷与FRAX评估SpA患者HF及MOF呈负相关性，左骶髂关节CT分级与其呈正相关性，β胶原降解产物与MOF风险呈正相关性。结论 SpA患者骨折风险高于健康人群。FRAX评估SpA患者的骨折风险时，使用BMD的FRAX较不使用时检测效能高，在已检测BMD的患者结合校正FRAX中的RA选项可以提高FRAX的检测效能。腰椎BMD、血磷、左骶髂关节病变分级、β胶原降解产物也是SpA患者骨折风险的影响因素。 |
| 英文摘要: |
| Objective To assess the fracture risk of patients with spondyloarthritis (SpA) using the Fracture Risk Assessment Tool (FRAX) and to conduct related risk factor analysis, exploring the applicability of different FRAX models in detecting SpA patients. Methods A total of 130 patients with SpA were enrolled as the patient group, and 130 healthy individuals undergoing health examinations during the same period were selected as the control group. FRAX was used to evaluate the probability of major osteoporotic fractures (MOF) and hip fractures (HF) in the next 10 years for both groups. Additionally, modified FRAX models were employed to assess fracture risk in the patient group, comparing their similarities and differences. Results ①Regardless of whether bone mineral density (BMD) was included, the risks of MOF and HF in the patient group were higher than those in the control group. When assessed using FRAX without BMD, the MOF risk of SpA patients was significantly higher at 1.57±0.87 than that in the control group at 1.36±0.57 (P<0.001). The HF risk was significantly higher at 0.22±0.43 than that in the control group at 0.13±0.13 (P=0.019). When assessed using FRAX with BMD, the MOF risk was significantly higher at 2.60±5.10 than that in the control group at 1.37±0.47 (P=0.007). The HF risk was significantly higher at 1.11±4.83 than that in the control group at 0.11±0.11 (P=0.019); ②When assessed SpA patients using the FRAX model without BMD, whether the option of using SpA instead of rheumatoid arthritis (RA) (SpA-FRAX) was selected, the results reached the same intervention threshold. No MOF patients and only 2 HF patients (1.5%) reached the intervention threshold. The detection efficiency improved when assessed using FRAX with BMD, with 2 MOF patients (1.5%) and 9 HF patients (6.2%) reaching the intervention threshold. When using the SpA instead of RA option (SpA-FRAX-BMD), the MOF detection results remained the same with 2 patients (1.5%), but the HF detection results increased to 13 patients (9.2%); ③The femoral neck BMD in the patient group was significantly lower than that in the control group, and 91% of patients had 25-hydroxyvitamin D3 levels below normal; ④The results of multiple regression analysis showed that lumbar BMD and blood phosphorus were negatively correlated with FRAX assessment of HF and MOF in SpA patients, while the CT grade of the left sacroiliac joint was positively correlated with them. β collagen degradation products were positively correlated with the risk of MOF. Conclusion The risk of fractures in SpA patients is higher than that in healthy people. When FRAX is used to assess the risk of fractures in SpA patients, the detection efficiency is higher when BMD is included than when it is not. For patients who have already undergone BMD testing, combining the RA option in the corrected FRAX may improve the detection efficiency of FRAX alone. Lumbar BMD, blood phosphorus, left sacroiliac joint lesion grading, and β collagen degradation products are factors that affect the risk of fractures in SpA patients. |
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