基于ROC曲线探讨无锡地区健康绝经后女性无骨密度FRAX^(■)干预阈值  

Intervention Threshold of FRAX®Without Bone Mineral Density in Healthy Postmenopausal Women in Wuxi Area Based on ROC Curve

作　　者：廖翼涛 张贤[2] 邱峰 刘小峰 李超[2] LIAO Yitao;ZHANG Xian;QIU Feng;LIU Xiaofeng;LI Chao(Graduate School,Nanjing University of Chinese Medicine,Nanjing Jiangsu 210038,China;不详)

机构地区：[1]南京中医药大学研究生院,江苏南京210038 [2]南京中医药大学无锡附属医院骨伤科 [3]无锡市新吴区中医医院骨伤科

出　　处：《联勤军事医学》2024年第1期31-35,共5页Military Medicine of Joint Logistics

基　　金：无锡市卫健委科研面上项目(M202114)。

摘　　要：目的在不使用骨密度的情况下探讨无锡地区相对健康绝经后女性最佳FRAX^(■)干预阈值,旨在不浪费过多资源的前提下有效地识别出患有骨质疏松症(osteoporosis,OP)的潜在人群。方法将在作者医院随机招募的符合纳排标准的124名50岁以上健康绝经后女性作为研究对象,以65岁为分界年龄分为50~65岁组(n=86)和>65岁组(n=38)。收集受试者年龄、体质量指数(body mass index,BMI)、既往骨质疏松性骨折史、慢性病史等个人信息。使用FRAX^(■)软件得出受试者髋部骨折的概率(probability of hip fractures,PHF)、主要骨质疏松性骨折概率(probability of major osteoporotic fractures,PMOF),以骨密度T值是否小于-2.5为状态变量,不输入骨密度T值的PHF、PMOF为检验变量,运用受试者工作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)分析其临床筛选OP的效能,确定无锡地区相对健康绝经后中老年女性最佳干预阈值。结果50~65岁组OP患者39人(45.35%),>65岁组OP患者23人(60.53%)。ROC曲线分析结果显示,50~65岁组PHF AUC为0.771,灵敏度为0.718,特异度为0.681,最佳阈值为0.7%;PMOF AUC为0.748,灵敏度为0.667,特异度为0.723,最佳阈值为3.4%。>65岁组受试者PHF AUC为0.554,灵敏度为0.783,特异度为0.400;PMOF AUC为0.546,灵敏度为0.826,特异度为0.400,>65岁组PHF、PMOFAUC接近0.5,说明预测的准确性较低。按照《原发性骨质疏松症诊疗指南》推荐PHF、PMOF阈值划分骨折风险,50~65岁组全为骨折低风险人群,>65岁组30人为低风险、8人为高风险人群,此结果低估了本研究患者的骨折风险。结论推荐PHF为0.7%、PMOF为3.4%为无锡地区50~65岁健康绝经后女性FRAX^(■)干预阈值,大于该阈值者建议进行骨密度检测,适当给予治疗措施;对于无锡地区65岁以上健康绝经后女性建议直接进行骨密度检测。Objective To explore the optimal intervention threshold of FRAX^(■) for postmenopausal women with relative health in Wuxi area without using bone mineral density,aiming to effectively identify potential populations with osteoporosis(OP)without wasting too many resources.Methods A total of 124 healthy postmenopausal women aged 50 years and above who met the inclusion criteria were randomly recruited from the author's hospital,they were divided into the 50-65-year-old group(n=86)and>65-year-old group(n=38)taking the age of 65 as the cutoff point.Personal in-formation such as age,body mass index(BMI),history of osteoporotic fractures and history of chronic diseases were col-lected from the subjects.The FRAX^(■) software was used to calculate the probability of hip fractures(PHF)and probabil-ity of major osteoporotic fractures(PMOF)for the subjects.Using whether the T-score of bone density was less than-2.5 as the state variable and the PHF and PMOF without incorporating the T-score of bone mineral density as the diag-nostic variables,the receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to analyze the efficiency of clinical screening for OP and determine the optimal intervention threshold for middle-aged and elderly postmenopausal women with relative health in Wuxi area.Results There were 39 patients with OP(45.35%)in the 50-65-year-old group and 23 patients with OP(60.53%)in the>65-year-old group.ROC curve showed that AUC of PHF in 50-65-year-old group was 0.771,the sensitivity was 0.718,the specificity was 0.681 and the best threshold value was 0.7%;the AUC of PMOF was 0.748,the sensitivity was 0.667,the specificity was 0.723 and the best threshold was 3.4%.The AUC of PHF in>65-year-old group was 0.554,the sensitivity was 0.783 and the specificity was 0.400;the AUC of PMOF was 0.546,the sensitivity was 0.826 and the specificity was 0.400,the AUC of PHF and PMOF in>65-year-old group was nearly 0.5,which indicating that the accuracy of the prediction was low.According to Guidelin

关 键 词：绝经后骨质疏松症 FRAX^(■) 髋部骨折的概率 主要骨质疏松性骨折概率 阈值 健康绝经后女性 

分 类 号：R25[医药卫生—中医内科学]