绝经后妇女骨质疏松风险简易筛选方法  

A simple risk screening method for osteoporosis in postmenopausal women

作　　者：宋亦军[1] 徐苓[1] 张淑兰[2] 吴宜勇[3] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院妇产科,北京100730 [2]北京解放军总医院妇产科 [3]卫生部北京医院妇产科

出　　处：《中国骨质疏松杂志》2006年第6期571-575,共5页Chinese Journal of Osteoporosis

基　　金：科技部十五攻关项目(2001BA702B03)

摘　　要：目的寻找一种经济、简便、科学、实用并易推广的骨质疏松高危人群的筛查方法,来预测骨质疏松的风险。方法对314例绝经后妇女进行骨质疏松相关危险因素简易问卷调查及髋部骨密度测定。通过单元线性回归分析寻找与股骨颈BMD值有显著相关性的变量,并通过多元线性回归分析,将各变量的回归系数标准化。根据筛选指数工作特征曲线(ROC),计算曲线下面积(AUC),找出最有意义的变量,组成最简单的筛选指数模式。结果经单元线性回归分析找出与股骨颈BMD有显著相关性的变量共12个,再通过多元线性回归分析,最后进入回归方程的有意义变量共有2个,即年龄,目前体重,最后得出筛选指数计算公式为筛选指数=INT(2×体重/10)-INT(3×年龄/10)。以-6作为筛选指数对骨量异常筛选的临界值,灵敏度为90.0%,特异度为49.3%。阳性预测值为54.5%,阴性预测值为88.3%。结论以年龄和体重作为骨质疏松风险的筛选指数筛选效度好,且简单、方便,而又经济。但此方法只能作为骨质疏松高危人群的筛查方法,不能代替骨密度检查作为骨质疏松症的诊断方法。必须考虑是否存在骨质疏松相关危险因素,以确定哪些妇女需要进一步进行骨密度检查,使高危人群得到及时治疗。Objective To develop a screening method for high risk populations for osteoporosis, which is economic, simple, scientific, and easy to perform. Methods Simple questionnaires had been designed to obtain risk factors associated with osteoporosis and hip BMD were also measured in 314 postmenopausal women. Univariate models were used to define statistically significant variables associated with BMD of the neck. Then multivariate models were constructed starting with all significant variables and the coefficient variables were standardized. The variables in the final linear model were used to develop an index for the purpose of evaluating the risk of having osteoporosis for the subjects. A receiver operating characteristic （ROC） curve was generated and the area under the curve （AUC） was also inspected. Results Twelve variables were selected which were significantly associated with the BMD of the neck using univariate models. The final multiple variable models included two significant variables： age and body weight. The formula for final index was： screening index = INT（2（Weight/10） -INT（3（Age/10）. Using a cut off of -6 yielded a sensitivity of 90.0%, specificity of 49.3%, positive predictive value of 54.5%, and negative predictive value of 88.3%. Conclusions The screening index based on only the two variables, age and body weight, is effective in screening for the risk populations of osteoporosis, and simple, convenient and economic. But this index can only be used as a screening test for osteoporosis instead of a diagnostic substitution for BMD measurement. Associated risk factors for osteoporosis must be considered when making a decision on who does need to have the BMD measured, thus proper management can be provided to the high risk ones.

关 键 词：骨质疏松 绝经 筛查 

分 类 号：R681[医药卫生—骨科学]