基于中医理论的绝经后骨质疏松症高危人群社区筛检工具研究

A Screening Tool for Community High Risk Population with Postmenopausal Osteoporosis Based on TCM Theory

目的初步建立基于中医理论的符合北京、上海社区人群特征绝经后骨质疏松症(PMOP)筛检工具。方法在上海市徐汇区和北京市东城区进行PMOP高危人群筛选,并对社区40～65岁妇女骨质疏松危险因素及证候调查问卷调查。根据广义偏线性模型(GPLM)结果进行筛检工具的建立,运用接收者工作特征曲线(ROC)评价筛检工具的判别准确度,通过ROC曲线下面积(AUC)评价筛检工具的诊断价值。结果将GPLM模型中各变量的参数估计值取Exp值,并取10倍值调整后得到筛检工具算式:Score=31.3×是否绝经+11.4×绝经年限-8.5×体重指数+14.4×下肢抽筋+13.8×下肢骨痛。筛检工具的AUC值为0.789(95%CI:0.766～0.812),与AUC=0.5比较,具有统计意义(P<0.05)。PMOP筛检工具的灵敏度为55.67%(95%CI:50.6%～60.6%),特异度为84.62%(95%CI:82.0%～87.0%),阳性预测值为63.0%(95%CI:57.7%～68.0%),阴性预测值为80.2%(95%CI:77.5%～82.8%),Youden指数为0.403。以-80为截断值,高危人群中63.0%患有骨质疏松,37.0%骨量正常;低危人群中19.8%患有骨质疏松,80.2%骨量正常。结论在PMOP筛检工具中融入中医证候特色内容,具有较好的灵敏度和特异度,可增加筛检工具对骨质疏松高危人群的判别准确性。

Objective To create a screening tool for postmenopausal osteoporosis （PMOP） in the community population in Beijing and Shanghai based on TCM theory. Methods The high risk population with postmenopausal osteoporosis was selected in Xuhui District, Shanghai and Dongcheng District, Beijing. A screening questionnaire survey was conducted with the questionnaire on osteoporosis risk factors and TCM syndromes of 40 to 65 years old community women. On the basis of generalized partial linear model （GPLM） analysis results, a PMOP screening tool was created. Receiver operating characteristic curve （ROC） was used to evaluate the discriminative accuracy of PMOP screening tool. The area under ROC curve （AUC） was used to assess the diagnostic value of PMOP screening tool. Results According to the parameters from GPLM, a mathematical formula of the PMOP screening tool was formed, i. e. score= 31.3 ×whether menopause＋ 11.4 × duration of menopause-8.5 × body mass index＋ 14.4 × lower limb cramps ＋ 13.8 ×lower limb pains. AUC value of the PMOP screening tool was 0. 789 （95%CI： 0. 766 to 0. 812）, with a statistical significance as compared with AUC= 0. 5 （P〈0.05）. The sensitivity of the PMOP screening tool was 55.67% （95%CI： 50.6% to 60.6%）, and specificity was 84.62% （95%CI： 82.0% to 87.0%）, the positive predictive value was 63.0% （95%CI： 57.7% to 68.0%）, the negative predictive value was 80. 2% （95%CI： 77. 5% to 82.8%）, and Youden index was 0. 403. According to the cun-off value -80, out of the high risk population （score≥- 80）, the osteoporosis group accounted for 63.0% and the normal bone mass group accounted for 37. 0%. Whereas, for the low-risk population （score〈--80）, 80.2% were normal bone mass, and only 19.8% were osteoporosis. Conclusion The addition of TCM syndrome into PMOP screening tool is more sensitive, specific and accurate for screening high risk PMOP population.