超声骨密度检查对社区绝经后妇女骨质疏松症筛查效果评价

Evaluation of the Effect of Calcaneus Quantitative Ultrasound Bone Mineral Density Test on the Screening of Osteoporosis in Postmenopausal Women

目的观察超声骨密度检查（QUS）对社区绝经后妇女骨质疏松症的筛查效果。方法 2011年8月—2012年7月,采用目的抽样法,在北京市西城区北区、西城区南区、东城区、海淀区各选择1个社区卫生服务机构,分别是首都医科大学附属复兴医院月坛社区卫生服务中心、广内社区卫生服务中心、天坛社区卫生服务中心、双榆树社区卫生服务中心,各社区卫生服务中心通过募集志愿者的方式征集研究对象,最终共选择符合纳入与排除标准的绝经后妇女717例为研究对象。根据年龄分为3组,≤59岁组304例,60-69岁组231例,≥70岁组182例。所有研究对象同时进行双能X线吸收仪（DXA）骨密度检测和QUS,以DXA骨密度检测为金标准。DXA骨密度检测股骨颈骨密度值,检查结果用T值表示;QUS测量双足跟骨骨密度,检查结果用T值表示,选取最低T值作为本研究数据。结果DXA骨密度检测结果显示,717例绝经后妇女中,241例（33.6%）骨量正常,341例（47.6%）骨量低下,135例（18.8%）骨质疏松症。各组绝经后妇女DXA骨密度比较,差异有统计学意义（P〈0.05）。随年龄增加,低T值（T值≤-2.5）比例增加（χ_（趋势）-2=123.381,P〈0.001）。QUS结果显示,717例绝经后妇女中,53例（7.4%）T值≥-1.0,152例（21.2%）-1.5≤T值〈-1.0,243例（33.9%）-2.0≤T值〈-1.5,156例（21.8%）-2.5〈T值〈-2.0,113例（15.8%）T值≤-2.5。各组绝经后妇女QUS骨密度比较,差异有统计学意义（P〈0.05）。随年龄增加,低T值比例增加（χ_（趋势）-2=47.643,P〈0.001）。DXA骨密度与QUS骨密度呈正相关（r=0.488,P〈0.05）。QUS诊断骨质疏松症的受试者工作特征曲线下面积（AUC）为0.793,95%CI（0.752,0.834）。QUS骨密度T值〈-2.0诊断骨质疏松症的AUC为0.734,95%CI（0.687,0.781）,T值=-2.0诊断骨质疏松症的灵敏度为75.6%、特异度为71.3%、总符合率为72.1%、Youden＇s指数为46.9%、Kappa值=0.339;T值〈-2.2诊断骨质疏松症的AUC为0.716,95%CI（0.664,0.768）,T值=-2.2诊断骨质疏松症的灵敏度为60.7%、特异度为82.5%、总符合率为78.4%、Youden＇s指数为43.2%、Kappa值=0.379。结论 QUS可以作为绝经后妇女骨质疏松症的筛查工具应用于社区;取T值=-2.0作为诊断的临界值有较好的灵敏度和特异度;确诊仍需进一步行DXA骨密度检测。

Objective To observe the effect of calcaneus quantitative ultrasound bone mineral density test（ QUS） on the screening of osteoporosis in postmenopausal women. Methods From August 2011 to July 2012,we chose one community health service center from each of four districts in Beijing, namely Beijing Xicheng North District, Xicheng South District,Dongcheng District and Haidian District,by purpose sampling method. The four community health service centers were Yuetan Community Health Service Center of Fuxing Hospital Affiliated to Capital Medical University, Guangnei Community Health Service Center,Tiantan Community Health Service Center and Shuangyushu Community Health Service Center. Volunteers were enrolled from each community health service center as subjects,and 717 postmenopausal women who accorded with inclusion and exclusion criteria were enrolled. According to age,the subjects were divided into three groups： ≤59 group（ n = 304）,60-69 group（ n = 231） and ≥70 group（ n = 182）. All subjects received bone mineral density test by both DXA and QUS,with the result of DXA as the golden criterion. The bone mineral density of femoral neck bone was measured by DXA,with T value showing the result. The bone mineral density of calcaneus of both feet was measured by QUS,with T value showing the result and the lowest T value was taken as research data. Results DXA bone mineral density test showed that,among 717 postmenopausal women,there were 241（ 33. 6%） subjects who had normal bone mineral density,341（ 47. 6%） subjects who had low bone mineral density,and 135（ 18. 8%） who had osteoporosis. The three groups were significantly different in the bone density tested by DXA（ P 〈 0. 05）. With age increasing,the proportion of subjects with low T value（ T value ≤- 2. 5） increased（ χ_（trend）~2= 123. 381,P 〈 0. 001）. QUS showed that,among 717 postmenopausal women,there were 53（ 7. 4%） with T value≥- 1. 0,and 152（ 21. 2%） with -1. 5≤T value -1. 0,243（ 33. 9%） with -2. 0≤T value -1. 5,156（ 21. 8%）with -2. 5 T value -2. 0,and 113（ 15. 8%） with T value ≤- 2. 5. The three groups were significantly different in the bone density of postmenopausal women tested by QUS（ P 〈 0. 05）. With age increasing,the proportion of subjects with low T value increased（ χ_（trend）^2= 47. 643,P 〈 0. 001）. The bone mineral density detected by DXA was positively correlated with that detected by QUS（ r = 0. 488,P 〈 0. 05）. The AUC of QUS diagnosing osteoporosis was 0. 793 with 95% CI（ 0. 752,0. 834）.The AUC of the T value of bone mineral density tested by QUS -2. 0 in the diagnosis of osteoporosis was 0. 734 with 95% CI（ 0. 687,0. 781）,and the sensitivity,specificity,total consistent rate,Youden＇s index and Kappa value of T value =-2. 0 in the diagnosis of osteoporosis were 75. 6%,71. 3%,72. 1%,46. 9% and 0. 339 respectively. The AUC of T value -2. 2 in the diagnosis of osteoporosis was 0. 716 with 95% CI（ 0. 664,0. 768）,and the sensitivity,specificity,total consistent rate,Youden＇s index,and Kappa value of T value =-2. 2 in the diagnosis of osteoporosis were 60. 7%,82. 5%,78. 4%,43. 2% and 0. 379. Conclusion QUS can be applied as a screening tool for osteoporosis in postmenopausal women. As a clinical value of diagnosis,T value =-2. 0 has good sensitivity and specificity,while the definite diagnosis needs further bone mineral density test by DXA.