住院骨质疏松症患者共病分析研究

doi:10.12114/j.issn.1007-9572.2019.00.779

摘要/Abstract

摘要： 背景　骨质疏松症患者常同时患有多种疾病，这些共病可能会进一步降低患者骨密度并增加骨折风险，给患者和社会带来更大的负担。目前对骨质疏松症与其他疾病共患关系的整体研究非常缺乏，难以帮助临床医生形成对骨质疏松症患者共病情况的全面了解。目的　探讨住院骨质疏松症患者的共病特征及共病对骨质疏松症的影响，以期提高相关科室医生的骨质疏松症诊疗能力，最终促进骨质疏松症整体诊疗水平并减轻患者负担。方法　2006年3月—2018年12月，四川大学华西医院共有37 559例住院患者诊断为骨质疏松症，按照排除标准排除6 197例后，最终纳入31 362例住院患者为研究对象。收集患者的诊断数据、骨密度数据，根据患者是否患有共病将其分为共病组和非共病组，比较两组腰椎、股骨颈、全髋骨密度；根据患者是否发生骨折将其分为骨折组和非骨折组，比较两组共病种数、各种疾病的共病率。结果　31 362例患者中，有共病者30 698例（97.88%），患者平均患共病种数为（4.0±2.2）种；发生骨折10 378例（33.09%）。共病率排名前3位的单病种分别是高血压（I10）、2型糖尿病（E11）和其他椎间盘疾患（M51），其共病率分别为41.41%、18.75%、15.88%；共病率排名前3位的系统疾病分别是肌肉骨骼系统和结缔组织疾病（M00-M99）、循环系统疾病（I00-I99）和内分泌、营养和代谢疾病（E00-E90），其共病率分别为42.27%、32.15%及31.25%。在24种（类）共病中，有14种（类）疾病的共病组腰椎骨密度高于非共病组（P<0.05），差异前3位的疾病分别为2型糖尿病（E11）、高血压（I10）和膝关节病（M17）；有3种（类）疾病的共病组腰椎骨密度低于非共病组（P<0.05），分别为血液及造血器官疾病和涉及免疫机制的某些疾患（D50-D89）、慢性阻塞性肺疾病（J44）和某些传染病和寄生虫病（A00-B99）。在24种（类）共病中，有4种（类）疾病的共病组股骨颈骨密度高于非共病组（P<0.05），差异前3位的疾病分别为膝关节病（M17）、肌肉骨骼系统和结缔组织疾病（M00-M99）及2型糖尿病（E11）；有12种（类）疾病的共病组股骨颈骨密度低于非共病组（P<0.05），差异前3位的疾病分别为慢性阻塞性肺疾病（J44）、血液及造血器官疾病和涉及免疫机制的某些疾患（D50-D89）和脑梗死（I63）。在24种（类）共病中，有5种（类）疾病的共病组全髋骨密度高于非共病组（P<0.05），差异前3位的疾病分别为2型糖尿病（E11）、膝关节病（M17）和其他椎间盘疾患（M51）；有9种（类）疾病的共病组全髋骨密度低于非共病组（P<0.05），差异前3位的疾病分别为慢性阻塞性肺疾病（J44）、血液及造血器官疾病和涉及免疫机制的某些疾患（D50-D89）和其他呼吸性疾患（J98）。骨折组共病种数大于非骨折组（P<0.05）。骨折组肌肉骨骼系统和结缔组织疾病（M00-M99），膝关节病（M17），损伤、中毒和外因的某些其他后果（S00-T98），某些传染病和寄生虫病（A00-B99），肿瘤（C00-D48）共病率低于非骨折组（P<0.05）；骨折组高血压（I10），循环系统疾病（I00-I99），内分泌、营养和代谢疾病（E00-E90），泌尿生殖系统疾病（N00-N99），消化系统疾病（K00-K93），呼吸系统疾病（J00-J99），慢性阻塞性肺疾病（J44），神经系统疾病（G00-G99），其他呼吸性疾患（J98），肝的其他疾病（K76），脑梗死（I63），慢性缺血性心脏病（I25），动脉粥样硬化（I70），血液及造血器官疾病和涉及免疫机制的某些疾患（D50-D89），精神和行为障碍（F00-F99）共病率高于非骨折组（P<0.05）。结论　住院骨质疏松症患者常与其他中老年人常见慢性病合并存在，应特别注意评估高血压、糖尿病、慢性阻塞性肺疾病和神经系统疾病患者的骨密度和脆性骨折发生风险；双能X线吸收测定法（DXA）低估骨性关节炎和其他肌肉关节疾病患者的骨密度时，可能需要行定量计算机体层摄影（QCT）骨密度检查或骨折风险评估工具〔如骨折风险评估量表（FRAX）〕进行诊断。

关键词: 骨质疏松, 共病现象, 骨密度, 骨折, 高血压, 糖尿病, 肺疾病, 慢性阻塞性

Abstract: Background　People with osteoporosis often have multiple coexisting diseases.These comorbidities may further decrease bone mineral density（BMD）and increase fracture risk，eventually putting a greater burden on patients and society.There are very few studies about the relationship between osteoporosis and comorbidities，which gives insufficient support to clinicians to comprehensively understand the comorbidities of osteoporosis.Objective　This study aimed to investigate the characteristics of comorbidities and their impact on osteoporosis in osteoporotic inpatients，improving clinicians' diagnostic and therapeutic levels and reducing the burden of such patients.Methods　From the totaled 37 559 inpatients with osteoporosis in West China Hospital of Sichuan University treated during March 2006 to December 2018，31 362 were enrolled after excluding 6 197.Data about diagnosis and BMD were collected.According to whether the patients have comorbidity，they were divided into comorbidity group and non comorbidity group，and the BMD of lumbar spine，femoral neck and total hip of the two groups were compared；according to whether the patients had fracture，they were divided into fracture group and non fracture group，and the number of comorbidity and the comorbidity rate of various diseases of the two groups were compared.Results　30 698（97.88%）were found with comorbidities，with an average number of comorbidities of（4.0±2.2），and 10 378（33.09%）of them had fractures.The top 3 comorbidities were essential（primary）hypertension（I10），type 2 diabetes（E11）and other intervertebral disc disorders（M51），with a prevalence of 41.41%，18.75%，and 15.88%，respectively.The top 3 coexisting systemic diseases were diseases of the musculoskeletal system and connective tissue（M00-M99），diseases of the circulatory system（I00-I99）and endocrine，nutritional and metabolic diseases（E00-E90），with a prevalence of 42.27%，32.15% and 31.25%，respectively.Among all the 24 comorbidities，there were 14 diseases that subjects complicated with anyone of them had higher lumbar vertebrae BMD than those without（P<0.05）.Those with the highest BMD increase were complicated with type 2 diabetes（E11），essential（primary）hypertension（I10）and gonarthrosis（M17）.There were 3 diseases，that subjects complicated with anyone of them had lower lumbar vertebral BMD than those without（P<0.05），including diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism（D50-D89），chronic obstructive pulmonary disease（J44）and certain infectious and parasitic diseases（A00-B99）.There were 4 diseases that subjects complicated with anyone of them had higher femoral neck BMD than those without（P<0.05）.Those with the highest BMD increase were complicated with gonarthrosis（M17），diseases of the musculoskeletal system and connective tissue（M00-M99）and type 2 diabetes（E11）.There were 12 diseases that subjects complicated with anyone of them had lower femoral neck BMD than those without（P<0.05）.Those with the most BMD decrease were complicated with chronic obstructive pulmonary disease（J44），diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism（D50-D89）and cerebral infarction（I63）.There were 5 diseases that subjects complicated with anyone of them had higher total hip BMD than those without（P<0.05）.Those with the highest BMD increase were complicated with type 2 diabetes mellitus（E11），gonarthrosis（M17）and other intervertebral disc disorders（M51）.There were 9 diseases that subjects complicated with anyone of them had lower total hip BMD than those without（P<0.05）.Those with the most BMD decrease were complicated with chronic obstructive pulmonary disease（J44），diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism（D50-D89）and other respiratory disorders（J98）.Subjects with osteoporotic fracture had more comorbidities than those without（P<0.05）.Subjects with osteoporotic fracture had lower prevalence of coexistence of diseases of the musculoskeletal system and connective tissue（M00-M99），gonarthrosis（M17），injury，poisoning and certain other consequences of external causes（S00-T98），certain infectious and parasitic diseases（A00-B99）and neoplasms（C00-D48）than those without（P<0.05）.Subjects with osteoporotic fracture had higher prevalence of coexistence of essential（primary） hypertension （I10），diseases of the circulatory system（I00-I99），endocrine，nutritional and metabolic diseases（E00-E90），diseases of the genitourinary system（N00-N99），diseases of the digestive system（K00-K93），diseases of the respiratory system（J00-J99），chronic obstructive pulmonary disease（J44），diseases of the nervous system（G00-G99），other respiratory disorders（J98），other diseases of liver（K76），cerebral infarction（I63），chronic ischaemic heart disease（I25），atherosclerosis（I70），diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism（D50-D89），and mental and behavioural disorders（F00-F99）than those without（P<0.05）.Conclusion　In this study，it was found that osteoporosis was often associated with other common chronic diseases in the elderly，and special attention should be paid to the evaluation of BMD and risk of fragility fracture in patients with hypertension，diabetes，chronic obstructive pulmonary disease and nervous system diseases.When DXA underestimates BMD in patients with osteoarthritis and other muscle-joint diseases，a QCT BMD exam or a fracture risk assessment tool such as FRAX may be required for diagnosis.

Key words: Osteoporosis；Comorbidity；Bone density；Fractures, bone；Hypertension；Diabetes mellitus；Pulmonary disease, chronic obstructive

许慎,卢春燕,王覃,等. 住院骨质疏松症患者共病分析研究[J]. 中国全科医学, 2020, 23(21): 2621-2630. DOI: 10.12114/j.issn.1007-9572.2019.00.779.
XU Shen,LU Chunyan,WANG Qin, et al. Analysis of comorbidities in inpatients with osteoporosis[J]. Chinese General Practice, 2020, 23(21): 2621-2630. DOI: 10.12114/j.issn.1007-9572.2019.00.779.

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