亚洲骨质疏松自我评价工具对成都地区中老年健康男性筛检效果的评价  

Performance of osteoporosis self-assessment screening tool for middle aged and elderly healthy Asians men in Chengdu

作　　者：黄际远[1] 宋文忠[1] 史克俭[1] 冯峡玉[1] 黄梅[1] 温群芳[1] 

机构地区：[1]四川省人民医院核医学科,成都610072

出　　处：《中华老年医学杂志》2014年第1期73-76,共4页Chinese Journal of Geriatrics

摘　　要：目的观察亚洲骨质疏松自我评价工具（OSTA）对成都地区中老年男性骨质疏松、低骨量的筛查效果评价。方法用双能X线骨密度仪（DXA）测定成都地区40岁以上健康男性4042例，测量部位包括腰椎（L1～4）、左股骨颈、大转子、Wards区、股骨干、全髋；根据公式计算OSTA得分，按OSTA〉～1、-4〈OSTA≤-1、OSTA≤-4将研究对象分为低危险性、中危险性、高危险性3级或按OSTA〉-1、OSTA≤-1分为低危险、中高危险两级双能X线骨密度仪（DXA）测定的不同部位T值进行对比，通过灵敏度、特异度、Kappa值、受试者工作特征曲线（ROC）下面积等指标进行评价。结果（1）随增龄腰椎、股骨骨质疏松及总的骨密度异常检出率增加，腰椎、股骨骨质疏松检出率80岁以上组分别达16．2％，24．0％。（2）OSTA指数三分类低、中、高危险组分别为：85．0％、11．0％、4．0％。腰椎、髋部骨质疏松检出率OSTA低危险组为2．6％、1．6％，中危险组为10．4％、10．4％；高危险组为29．3％、30．5％。（3）以OSTA≤-1为截断值，T值〈-1筛查灵敏度、特异度分别为28．1％～28．7％、89．0％～92．4％；T值≤2．5时分别为灵敏度51．6％～63．2％，特异度86．7％～86．8％。三分类OSTA与T值一致性Kappa值0．153、0．197，两分类Kappa值0．195、0．243。T值〈-1、≤一2．5腰椎、股骨OSTA指数ROC曲线下面积为0．689～0．823（P〈0．001），不同年龄组、不同部位OSTA指数ROC曲线下面积为0．639～0．899（P〈0．001）。结论OSTA指数对50岁以上男性骨质疏松筛查有一定价值；不同年龄组筛查效果不同。Objective To evaluate the screening effect of osteoporosis self-assessment tool for Asians （OSTA） in middle aged and elderly healthy men in Chengdu. Methods A total of 4042 healthy men aged 40 to 106 years received dual energy X-ray absorptiometry （DXA） assay, and OSTA index evaluation. Measurement sites included lumbar spine （L1-4）, left femoral neck, trochanter, Ward＇s area, total hip and femoral shaft. All persons were classified into highosteoporosis-group （OSTA≤- 4）, mediumosteoporosis-group （ - 4〈OSTA≤ - 1 ）, low osteoporosis-group （ OSTA〉 - 1）, or the low risk-group （OSTA〉-1） and high risk-group （OSTA≤-1） by OSTA scores. T-scores were compared between different measurement sites detected by DXA. The sensitivity, specificity, Kappa value and the area under receiver operating characteristic （ROC） curve （AUC） of OSTA in screening osteoporosis were evaluated. Results The prevalence of osteopenia and osteoporosis in lumbar spine, proximal femur were gradually increased along with aging. The detection rate of osteoporosis in lumbar spine and proximal femur were 16.2% and 24.0% respectively in subjects aged over 80 years. OSTA index in low-risk, medium-risk group, high-risk group were 85.0%, 11.0%, 4.0 % respectively. The detection rate of osteoporosis in lumbar spine and proximal femur were 2.6 % and 1.6% in low-risk group, 10.4%and 10.4% in medium-risk group, and 29.3% and 30.5% in high-risk group, respectively. Taking OSTA 4-1 as the cut-off value, the sensitivity and specificity of OSTA in screening osteoporosis in lumbar spine and femur by T-score〈-1 were 28.1%, 28.7%,89.0%and 92.4% respectively, and by T-score≤-2.5 were 51.6%, 63.2%, 86.7% and 86.8% respectively. The consistency of diagnosis result between T-score and OSTA index according to the three versus two risk levels was 0. 153 and 0. 197 versus 0. 195 and 0. 243 Kappa value, respectively. The AUC of OSTA index for lumbar spine and femur by T-scored - 1 and T-score≤ - 2.5 were 0. 689 and 0.

关 键 词：骨质疏松 多组筛查 

分 类 号：R580[医药卫生—内分泌]