跟骨定量超声联合亚洲人骨质疏松自我评价工具在筛查社区绝经后妇女骨质疏松症中的应用  

Combined use of calcaneal quantitative ultrasound with Asian osteoporosis self assessment tools in screening osteoporosis among postmenopausal women

作　　者：张彦[1] 刘和菊[2] 李春海[1] 陈庆瑜[3] 张弛[1] 傅光涛 丁悦[1] 

机构地区：[1]中山大学孙逸仙纪念医院骨外科,广州510000 [2]中山大学孙逸仙纪念医院健康教育宣传中心,广州510000 [3]中山大学孙逸仙纪念医院体检中心,广州510000

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2016年第2期143-148,共6页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：广东省公益研究及能力建设专项重大项目(2014B020212004)

摘　　要：目的探索定量超声法(quantitative ultrasound,QUS)与亚洲人骨质疏松自评工具(osteoporosis self-assessment tool for Asians,OSTA)均为评估亚洲人骨质疏松的一种简单有效的方法。单一运用上述两种方法进行骨质疏松筛查均未能达到理想的敏感度和特异度,二者结合进行骨质疏松症诊断的方法。方法选取2014年9至12月在广州市社区现场用跟骨定量超声仪检测的118位绝经后女性作为研究对象,检测跟骨密度并通过调查问卷形式获取受试者年龄、体质量指数等相关信息。并对这一部分受试者行腰椎双能X线扫描检查,根据排除标准最终入组104位。通过绘制ROC工作曲线,评价QUS联合OSTA评分进行骨质疏松筛查的可行性,并确定合适的高危指标。结果联合OSTA和QUS-T进行筛查时,拟合回归方程Y=-1.688×QUS-0.186×OSTA-3.973,高危指标为Y>-0.6142。预测值与双能X线检测法(dual-energy X-ray absorptiometry,DXA)诊断结果的受试者工作曲线(receiver operating characteristic curve,ROC)的曲线下面积(area under the ROC curve,AUC)=0.847,标准误(standard error,SE)=0.041,P=0.000,并联QUS-T与OSTA进行筛查诊断,以满足QUS-T≤-2.2或OSTA≤-3其中之一为高危指标,此时敏感度为89%,特异度为74%,约登指数0.63。结论联合QUS和OSTA进行骨质疏松症筛查,是一种具有较高价值的筛查方法,选择合适的高危指标,可以获得满意的敏感度和特异度,同时由于这一方法简便可行、性价比高,因此在社区人群的健康普查方面有较好的实践价值。Objective To explore the effectiveness of combining ealcaneal quantitative ultrasound （QUS） with Asian osteoporosis self assessment tools （OSTA） in screening osteoporosis among postmenopausal women. Methods From Sep.2014 to Dec.2014, bone mineral density （BMD） of 118 postmenopausal women was measured in Guangzhou communities by QUS and relative information such as their ages and BMI were required through questionnaire. BMD was measured by dual-energy x-ray absorptiometry （DXA）. By drawing receiver operating characteristic curve （ROC）, this research evaluated the feasibility of joined use of QUS and OSTA score in osteoporosis screening, and determined the appropriate cut-off point. Results When OSTA and QUS were combined for screening, the regression curve was fitted as Y=-1.688×QUS-0.186×OSTA-3.973. Meanwhile, the area under the ROC （AUC） drawn by predicted value and DXA screening result was 0.847, SE =0.041, P =0.000. AUC=0.847, SE=0.041, P=0.000. When QUS-T and OSTA were used parallelly, the cut-off point set by OSTA≤-3 and QUS-T≤-2.2 could achieve the following figures： Youden index as 0.63, while sensitivity was 89% and specificity was 74%. Conclusion QUS and OSTA score were simple and economic methods of predicting the incidence of osteoporosis among the elderly. Setting the appropriate Qus and OSTA threshold could approch a good accuracy. It was worth in screening of osteoporosis.

关 键 词：骨质疏松症 定量超声 亚洲人骨质疏松症自评工具 骨密度检测 

分 类 号：R681[医药卫生—骨科学]