CAJ | 학술논문

目的：了解计算骨折危险性评估工具（ fracture risk assessment tool ，FRAX）时，使用与不使用骨密度（ bone mineral density，BMD）对中国类风湿关节炎（rheumatoid arthritis，RA）患者骨折概率的影响，分析影响骨量的因素。方法：2009年12月至2012年12月于北京大学第一医院门诊及病房首次就诊的年龄大于40岁RA患者200例，双能X线测定腰椎和左髋部BMD，将使用与不使用BMD或T值计算的FRAX骨折概率进行比较，并结合患者的性别、年龄、绝经时间、体重指数、病程以及激素应用等因素进行相关性分析。结果：200例患者平均年龄（59．4±10．2）岁，77．5％为女性。有77例患者接受了双能X线检查，其中BMD正常和异常组分别为10例（13％）和67例（87％），有32例患者发生骨折。两组患者在平均年龄、糖皮质激素使用（用药时间、累积剂量、目前日平均剂量）、FRAX预测主要部位和髋部骨折风险之间差异均有统计学意义。使用与不使用BMD、T值计算的未来10年骨折概率差异无统计学差异。结合T值得出的FRAX预测骨折风险的ROC曲线下面积最大（0．899）。以腰椎及髋部的BMD作为结果变量，对影响患者BMD的因素进行多元回归分析显示：患者的疼痛评分（P＝0．02）、既往发生骨折（P＝0．003）、糖皮质激素的累积剂量（P＝0．008）是引起腰椎骨量异常的危险因素，患者的年龄（P＜0．001）、已绝经（P＝0．05）、既往发生骨折（P＝0．003）、体重指数（P＝0．03）是引起左髋部骨量异常的危险因素。结论：RA患者骨折发生比例较高，主要部位和髋部骨折风险均增加，结合股骨颈BMD或T值计算FRAX能更有效地预测骨折概率。
목적：료해계산골절위험성평고공구（ fracture risk assessment tool ，FRAX）시，사용여불사용골밀도（ bone mineral density，BMD）대중국류풍습관절염（rheumatoid arthritis，RA）환자골절개솔적영향，분석영향골량적인소。방법：2009년12월지2012년12월우북경대학제일의원문진급병방수차취진적년령대우40세RA환자200례，쌍능X선측정요추화좌관부BMD，장사용여불사용BMD혹T치계산적FRAX골절개솔진행비교，병결합환자적성별、년령、절경시간、체중지수、병정이급격소응용등인소진행상관성분석。결과：200례환자평균년령（59．4±10．2）세，77．5％위녀성。유77례환자접수료쌍능X선검사，기중BMD정상화이상조분별위10례（13％）화67례（87％），유32례환자발생골절。량조환자재평균년령、당피질격소사용（용약시간、루적제량、목전일평균제량）、FRAX예측주요부위화관부골절풍험지간차이균유통계학의의。사용여불사용BMD、T치계산적미래10년골절개솔차이무통계학차이。결합T치득출적FRAX예측골절풍험적ROC곡선하면적최대（0．899）。이요추급관부적BMD작위결과변량，대영향환자BMD적인소진행다원회귀분석현시：환자적동통평분（P＝0．02）、기왕발생골절（P＝0．003）、당피질격소적루적제량（P＝0．008）시인기요추골량이상적위험인소，환자적년령（P＜0．001）、이절경（P＝0．05）、기왕발생골절（P＝0．003）、체중지수（P＝0．03）시인기좌관부골량이상적위험인소。결론：RA환자골절발생비례교고，주요부위화관부골절풍험균증가，결합고골경BMD혹T치계산FRAX능경유효지예측골절개솔。
Objective:To verify the fracture risk assessment tool ( FRAX) to estimate the probability of osteoporotic fracture in patients with rheumatoid arthritis ( RA ) with or without bone mineral density (BMD), and identify associated risk factors of osteoporosis .Methods: In the study, 200 patients with rheumatoid arthritis aged more than 40 years in Peking University First Hospital from Dec .2009 to Dec. 2012 were recruited.Clinical information was obtained from a questionnaire of their case history and medical records.FRAX tool was administered.Their lumber spine and left femoral BMD were determined by dual energy X ray absorptiometry.The gender, age, disease duration, menopause status, body mass index ( BMI) and accumulative dose of glucocorticoid were obtained in retrospect .Correlation analysis was conducted between the BMD and clinical information .Results:The study population ( female, 77.5%) had a mean age of 59.4 years, in which 10 (13%) patients showed a normal BMD, 67 (87%) were osteopenia or osteoporosis , while 32 patients (16%) had fragile fracture.Compared with the patients with normal BMD, the subjects with low BMD had significantly older age , longer period for corticoids usage , higher day dose and accumulated dose of corticoids .The 10-year fracture risk of sustai-ning major osteoporotic fractures and hip fracture was higher .No significant difference was observed be-tween the 10-year fracture risks calculated with BMD and without BMD .The values of the different area under the receiver operating characteristic ( ROC) curve ( AUC) for major and hip fractures calculated in three ways:without BMD, with the femoral neck BMD, and with T-score.The best result was for FRAX tool for hip fracture with the T-score ( AUC 0 .899 ) .A stepwise multivariate linear regression model was constructed to explore the relationship between the different clinical factors studied and a low BMD . Three statistically significant variables for lumber BMD were pain on visual assessment scale ( VAS ) (P=0.02), fracture history (P=0.003) and a higher steroid accumulated dose (P=0.008).Three statistically significant variables for left hip BMD were age (P<0.001), fracture history (P=0.05) and lower BMI ( P=0.03) .Conclusion:Low BMD is a common complication in RA patients .Risk factors for major fracture and hip fracture are increased .There is a positive correlation between FRAX calculated with and without BMD or T score .FRAX with the femoral neck T score or BMD presents a discriminatory capacity better than FRAX without BMD , according to the AUC ROC .