25~49岁女性全身骨量减少风险自评估工具的研制与检验  

The Development and Verification of Osteopenia Risk Assessment Tool for Women Aged 25 to 49

作　　者：崔新雯 张一民[2] Cui Xinwen;Zhang Yimin(China Institute of Sport Science,Beijing 100061,China;Beijing Sports University,Beijing 100084,China)

机构地区：[1]国家体育总局体育科学研究所,北京100061 [2]北京体育大学,北京100084

出　　处：《中国运动医学杂志》2020年第8期607-614,共8页Chinese Journal of Sports Medicine

基　　金：国家“十二五”科技支撑计划课题(2012BAK21B00)。

摘　　要：目的:研制筛检效果良好、操作简便易行的25~49岁女性全身骨量减少风险评估工具,并检验其应用效果。方法:对149名25~49岁健康女性,采用双能X线骨密度测量仪对体成分进行测试,对骨密度影响因素进行问卷调查。以测得的全身骨密度的T值作为骨量减少(-2.5<T<-1)的判定金标准,采用Logistic回归分析建立全身骨量减少风险评估模型(全身骨量减少=-1,全身骨量正常=0),绘制ROC曲线,并根据ROC曲线下的面积(AUC)、灵敏度、特异度等指标评价模型,确定临界值,并建立评估工具,通过外部样本回代验证评估工具的应用效果。结果:(1)全身骨量减少风险评估模型的预测变量为总身体活动水平、18~30岁之间的体育锻炼和体重。(2)全身骨量减少风险评估工具为W=18~30岁的体育锻炼(是=2;否=4)-总身体活动水平(低=0;中=1;高=2)-0.2×体重(kg),以-9为临界值,W≤-9为骨量减少低风险,W>-9为骨量减少高风险,此时的灵敏度为87.5%,特异度为74.0%,符合率为75%,AUC为0.868(P=0.000)。(3)评估工具的应用效果检验一致性Kappa值为0.546(P=0.016),应用于筛检34人骨量减少的AUC为0.944(P=0.021),灵敏度为100%,特异度为75.0%。结论:本研究所建立的25~49岁女性骨量减少风险评估工具为:W=18~30岁的体育锻炼(是=2;否=4)-总身体活动水平(低=0;中=1;高=2)-0.2×体重(kg),临界值为-9,可作为25~49岁女性全身骨量减少高风险的简单有效的筛检方法。Objective To develop a well-screened and convenient osteopenia risk assessment tool for women aged 25 to 49,and evaluate its effect.MethodTotally 149 women aged 25 to 49 were evaluated using the of dual-energy x-ray absorptiometry(DXEA)and surveyed using a questionnaire.The bone mineral density(BMD)T-score(-2.5<T<-1)was used as the golden standard for osteopenia.The logistic regression analysis was used to develop the model for the osteopenia risk assessment.The area under the curve(AUC),sensitivity,specificity and other assessment indexes were adopted to evaluate the model and identify the cut-off.Results The predictor variables of the osteopenia risk assessment model were physical exercise between 18 to 30,weight and total physical activity level.The osteopenia risk assessment tool was W=the activity between 18 to 30(Yes=2;No=4)-total physical activity level(Low=0;Middle=1;High=2)-0.2×weight(kg),with the cut-off of-9,resulting in the AUC,sensitivity and specificity of 0.868(P=0.000),87.5% and 74.0% respectively.The application evaluation indexes Kappa,AUC,sensitivity and specificity was 0.546(P=0.016),0.944,100% and 75.0% respectively.Conclusion The osteopenia risk assessment tool for women aged 25 to 49 was:W=the activity between 18 to 30-physical activity level-0.2×weight,with the cut-off of-9,which is convenient and effective to screen the high risk of osteopenia.

关 键 词：25~49岁女性 骨密度 骨量减少 自评估 筛检 二元Logistic回归分析 ROC曲线 

分 类 号：R580[医药卫生—内分泌]