绝经后骨质疏松症患者初次骨折的影响因素及预测价值分析  

Analysis of influencing factors and predictive value of initial fracture in postmenopausal osteoporosis patients

作　　者：张佳杨 杨寅[2] 丁万超 ZHANG Jiayang;YANG Yin;DING Wanchao(School of Nursing,Shaanxi University of Chinese Medicine,Xianyang 712046,Shaanxi Province,China;Second Department of Orthopedics,Xi'an Central Hospital,Xi'an 710000,Shaanxi Province,China)

机构地区：[1]陕西中医药大学护理学院,陕西咸阳712046 [2]西安市中心医院骨外二科,西安710000

出　　处：《医学新知》2024年第12期1369-1377,共9页New Medicine

基　　金：陕西省重点研发计划项目(2023-YBSF-655);西安市科技计划(22YXYJ0032)。

摘　　要：目的研究绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)患者初次骨折(initial fracture,IF)的影响因素。方法回顾性收集2018年1月至2023年12月就诊于西安市中心医院骨科、内分泌科的PMOP患者的临床资料,根据骨折史将患者分为分为IF组和未骨折(non-fracture,NF)组。采用Logistic回归分析PMOP患者发生IF的影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线及其曲线下面积(area under curve,AUC)探讨相关指标的预测价值。结果共纳入370例PMOP患者,其中IF组256例,NF组114例,IF发生率为69.19%。Logistic回归分析结果显示,高约翰霍普金斯跌倒风险评估量表(JHFRAT)评分[OR=1.339,95%CI(1.151,1.557)]、高中性粒细胞与淋巴细胞比值(NLR)[OR=2.163,95%CI(1.105,4.237)]、碱性磷酸酶(ALP)升高[OR=1.014,95%CI(1.004,1.024)]是PMOP患者发生IF的危险因素;而居住地为城市[OR=0.333,95%CI(0.113,0.984)]、高骨密度(BMD)[OR=0.609,95%CI(0.395,0.937)]、高全身免疫炎症指数(SII)[OR=0.998,95%CI(0.997,0.999)]、高尿酸(UA)[OR=0.992,95%CI(0.987,0.997)]是PMOP患者发生IF的保护因素。ROC曲线分析结果显示,联合三项指标(JHFRAT评分+NLR+SII)的AUC为0.834[95%CI(0.792,0.876)]。结论PMOP患者JHFRAT评分较高、NLR与ALP水平较高,以及BMD、SII、UA水平较低会增加IF发生风险,其中联合JHFRAT评分、NLR、SII对于IF有着较高的预测价值。Objective To investigate the factors affecting initial fracture(IF)in postmenopausal osteoporosis(PMOP).Methods The clinical data of PMOP patients who visited the department of orthopedics and endocrinology of Xi'an Central Hospital from January 2018 to December 2023 were retrospectively collected,and patients were divided into the IF group and non-fracture(NF)group based on their fracture history.Logistic regression was used to analyze the factors influencing the occurrence of IF in PMOP patients.Receiver operating characteristic(ROC)curves and area under the curve(AUC)were used to explore the predictive value of relevant indicators.Results A total of 370 PMOP patients were included,with 256 in the IF group and 114 in the NF group.The incidence of IF was 69.19%.Logistic regression analysis showed that higher Johns Hopkins Fall Risk Assessment Tool(JHFRAT)scores[OR=1.339,95%CI(1.151,1.557)],higher neutrophil-to-lymphocyte ratio(NLR)[OR=2.163,95%CI(1.105,4.237)],and elevated alkaline phosphatase(ALP)levels[OR=1.014,95%CI(1.004,1.024)]were risk factors for IF in PMOP patients.In contrast,living in an urban area[OR=0.333,95%CI(0.113,0.984)],higher bone mineral density(BMD)[OR=0.609,95%CI(0.395,0.937)],higher systemic immune-inflammation index(SII)[OR=0.998,95%CI(0.997,0.999)],and higher uric acid(UA)levels[OR=0.992,95%CI(0.987,0.997)]were protective factors.ROC curve analysis showed that the AUC for the combined three indicators(JHFRAT score+NLR+SII)was 0.834[95%CI(0.792,0.876)].Conclusion In PMOP patients,higher JHFRAT scores,NLR,and ALP levels,as well as lower BMD,SII,and UA levels,increase the risk of IF.The combination of JHFRAT score,NLR,and SII has high predictive value for IF.

关 键 词：绝经后骨质疏松 初次骨折 影响因素 受试者工作特征曲线 

分 类 号：R683[医药卫生—骨科学]