未绝经女性骨量减少风险自评估方法的建立

Establishing Self-Assessment Method of Osteopenia Risk for Premenopausal Women

目的：建立筛检效果良好且简便易行的未绝经女性骨量减少风险自评估方法,丰富体质健康自评体系,为预防骨质疏松的发生提供技术保障。方法：采用双能X线吸收测量法（DEXA）测试150名健康未绝经女性的正位腰椎（L2-L4）骨密度和身体成分,并进行骨密度影响因素的问卷调查,以DXEA测腰椎骨密度所得的T值作为判断骨量减少（T〈-1）的金标准,通过二分类Logistic回归分析建立腰椎骨量减少风险自评估模型（腰椎骨量减少=1,腰椎骨量正常=0）,对自评估模型进行ROC曲线分析,根据ROC曲线下的面积（AUC）、灵敏度、特异度、符合率等指标建立具有良好筛检效果的骨量减少风险自评估方法。最后利用外部样本验证自评估方法的应用效果。结果：骨量减少风险自评估模型的预测变量为休闲性身体活动（OR=0.059,95%CI：0.008-0.462）和体重（OR=0.914,95%CI：0.850-0.982）。骨量减少风险自评估方法,即I=-40×休闲性身体活动-体重,筛检骨量减少高风险的AUC为0.825（95%CI：0.728-0.921）,以-105.44为临界值,I≤-105.44为骨量减少低风险,I〉-105.44为骨量减少高风险,此时的灵敏度为88.2%（95%CI：67%-99%）,特异度为61.9%（95%CI：53.1%-70.9%）,符合率为65.2%（95%CI：57.2%-73.2%）。外部样本验证得到骨量减少风险自评估方法的筛检结果与金标准的诊断结果一致性尚可（Kappa为0.471）,应用于筛检15人骨量减少的100%（95%CI：16%-100%）,特异度为76.9%（95%CI：46%-95%）,符合率为80%（95%CI：52%-96%）。结论：建立了骨量减少风险自评估方法为I=-40×休闲性身体活动-体重,临界值为-105.44,I≤-105.44为骨量减少低风险,I〉-105.44为骨量减少高风险,该方法筛检效果良好,可以作为筛检未绝经女性骨量减少高危人群有效、实用的方法。

Objective： The purpose of this study was to establish the self-assessment method of Osteopenia risk for the premenopausal women,hoping to provide technical support for preventing Osteoporosis. Methods： The lumbar bone mineral density（ BMD） and body composition of 150 25-49 years old healthy young women were measured by dual-energy x-ray absorptiometry（ DXA）,and the influencing factors of lumbar BMD were investigated by questionnaires. The T value of lumbar BMD measured by DXA was the gold standard to identify Osteopenia（ T -1）. The self-assessment model of Osteopenia risk was established by binary Logistic regression analysis（ Osteopenia = 1,normal bone mass = 0）,and was analyzed by ROC curve with the indicators of AUC,sensitivity,specificity and coincidence rate. This method was tested by external samples. Results： The predictive indicators of the self-assessment model of Osteopenia risk are leisure physical activity（ OR = 0. 059,95% CI： 0. 008-0. 462）and body weight（ OR = 0. 914,95% CI： 0. 850-0. 982）. The self-assessment method is the equation： I =-40× Leisure physical activity-body weight,the cut point of I is-105. 44,which means that I≤-105. 44 is low risk of Osteopenia,I -105. 44 is high risk of Osteopenia,and the cut point of AUC is 0. 825（ 95% CI： 0. 728-0. 921）,the sensitivity is 88. 2%（ 95% CI： 67%-99%）,the specificity is 61. 9%（ 95% CI： 53. 1%-70. 9%）,the coincidence rate is 65. 2%（ 95% CI： 57. 2%-73. 2%）. The risk screening results of establishedself-assessment method of Osteopenia risk are similar to the results of gold standard（ Kappa = 0. 471）,the 15 people screened by self-assessment method are 100% Osteopenia（ 95% CI： 16%-100%）,the specificity is76. 9%（ 95% CI： 46%-95%）,the coincidence rate is 80%（ 95% CI： 52%-96%）. Conclusions： The established self-assessment method of Osteopenia risk is： I =-40 × Leisure physical activity-body weight,the cut point of I is-105. 44,which means that I≤-105. 44 is low risk of Osteopenia,I -105. 44 is high risk of Osteopenia. This method is good,can be used as an effective and practical method for screening the high risk people of Osteopenia for the premenopausal women.