上海市绝经后妇女低骨量的简易筛选方法的建立和验证  

Development of a simple predicting tool for low bone mass of postmenopausal women:a study in Shanghai

作　　者：黄琪仁[1] 章振林[1] 周琦[1] 朱国英[2] 秦跃娟[1] 张浩[1] 胡云秋[1] 李淼[1] 刘玉娟[1] 

机构地区：[1]上海交通大学附属第六人民医院骨质疏松科和骨质疏松研究室,200233 [2]复旦大学放射医学研究所

出　　处：《中华医学杂志》2007年第12期808-811,共4页National Medical Journal of China

基　　金：国家"十五"科技攻关计划课题基金(2001BA702B03)

摘　　要：目的建立一项简易的绝经后妇女低骨量筛选的方法。方法经筛选获得405名上海市绝经后健康妇女,填写有关低骨量危险因素的问卷调查表,并使用双能 X 线吸收仪测定股骨颈骨密度(BMD)以诊断骨质疏松(T 值≤-2.5)。将股骨颈 BMD 与危险因素进行单元回归分析,得到有统计学意义的变量与股骨颈 BMD 进行多元回归分析,以进一步剔除无统计学意义的变量,将筛选出来的变量建立筛选指数模型,应用此模型中的变量计算筛选指数(Index)。将筛选指数做工作特征曲线(ROC 曲线),分析曲线下面积(AUC),决定最终模型的参数。结果建立筛选指数仅由年龄和体重两个参数组成。筛选指数=2×体重(kg)/10+[-1×年龄(岁)/10]。这项 Index 的灵敏度为93.4%,特异度为52.6%,它的 AUC 为0.818(95%可信度:0.766～0.870)。高危险人群组骨质疏松的患病率为58%,中等危险人群和低危险人群的患病率各为26%和2%。结论此筛选方法,可以帮助临床简便评价绝经后妇女的骨量状况,筛选出骨质疏松高危和低危人群。对低危险人群组,可能不必进行 BMD 检查,以节省检测费用。Objective To develop a simple screening tool for low bone mass of postmenopausal women. Methods 405 postmenopausal women in Shanghai who visited the department of osteoporosis consecutively, aged 62. 8 ± 8. 0 （47 -90 ）, underwent questionnaire survey on the risk factors of osteoperosis and fracture. Dual energy X-ray absorptiometry （DXA） was conducted on the left or right femoral neck to measure the bone mineral density （ BMD ） to identify osteoporosis （ T-score ≤ - 2.5 ）. Univariate linear regression was conducted to identify the variables with significant association with the femoral neck BMD to be used in multiple variable regression analysis. The screening index was obtained by the formula： index = independent variable X corresponding weight. A receiver operating characteristic （ROC） curve was drawn with the sensitivity （ true positive rate） as the vertical coordinate and 1 - specificity （false positive rate ） as the horizontal coordinate. The area under the ROC curve （AUC ROC ） was calculated so as to establish a parsimonious model. Results The final tool was based only on age and body weight. The formula of screening index was： index = 2 x weight （kg）/10 ＋ [ - 1 × age （year） /10 ]. The risk index thus obtained had a sensitivity of 93.4 %, a specificity of 52.6 %, and an AUC ROC of 0. 818 （95% CI for the mean： 0.766 -0.870）. 58 % of the high-risk women had osteoporosis, compared with 26 % and 2 % of the intermediate and low-risk women respectively. Conclusion The established and verified screening tool can easily predict the bone mass status in the postmenopausal women, thus screening the highrisk population and saving the cost of BMD measurement unnecessary for the low-risk population.

关 键 词：骨质疏松 骨密度 筛查 

分 类 号：R580[医药卫生—内分泌]