基于决策树方法分析住院精神分裂症患者骨密度异常的影响因素

Influencing factors of reduction of bone mineral density among inpatients with schizophrenia based on decision tree algorithm

目的 探索影响住院精神分裂症患者骨密度异常的相关因素,为预防骨质疏松和骨折提供参考.方法 选取天津市精神卫生中心2015年1~7月住院的精神分裂症患者,采用自制问卷进行调查,收集被试的社会经济状况、既往病史、治疗史、骨密度、催乳素（PRL）等生化指标及住院期间的饮食、运动情况;按照骨密度是否异常进行分组,采用决策树方法探讨影响骨密度异常的因素.结果 444例住院精神分裂症患者中,存在骨密度异常的有300例（67.57%）,其中骨质疏松者156例（35.14%）.＂有无骨折史＂是住院精神分裂症患者骨密度异常的首要影响因素（χ2=46.347,P〈0.01）,＂饮用咖啡浓茶＂（χ2=55.424,P〈0.01）和＂每天室内运动＂（χ2=31.191,P〈0.01）是二阶节点,三阶节点为＂吃豆制品＂（χ2=35.801,P〈0.01）和＂血钙水平＂（χ2=25.281,P〈0.01）.结论 住院精神分裂症患者中,骨密度异常状况严重;既往骨折史对于住院患者预防骨质疏松意义重大,对于有骨折史的患者,适当增加室内运动可以减少骨质疏松的发生;对于无骨折史的患者,除了定期监测其骨钙值以外,还应加强对其膳食习惯的干预.

Objective To explore the related factors that associated with the Bone Mineral Den-sity（BMD） among the inpatients with schizophrenia, in order to provide better invention for osteopenia and osteoporosis.Methods Totals of 444 psychiatric inpatients with schizophrenia were selected from wards of the Tianjin Mental Health Center since January 2015 to July 2015. All participants were assessed by self-made questionnaire which included the socioeconomic status, past medical history, medications, dietary status and activity status, in addition of the clinical parameters, such as bone mineral density（BMD）, serum prolactin（PRL） and blood calcium. All participants were divided into 3 groups according to the BMD, and the decision tree model was created to identify the influencing factors of the reduction of BMD.Results There were 300（67.57%） inpatients with decreasing BMD and 156（35.14%） with osteoporosis.＂fracture history＂ was the first parent node of the model（χ2=46.347,P〈0.01）.＂drinking coffee and strong tea＂（χ2=55.424,P〈0.01） and＂daily indoor activity＂（χ2=31.191,P〈0.01） became the parent nodes on the second layer. On the 3rd layer, the nodes were＂eating bean products＂（χ2=35.801,P〈0.01） and＂serum calcium concentration＂（χ2=25.281,P〈0.01）.Conclusions The reduction of BMD among inpatients with schizophrenia is serious. The fracture history is quite significant for prevention of osteoporosis. For inpatients with fracture history, the moderate indoor activities are the protective measures. While for the inpatients without it, interventions on dietary are more meaningful in addition to surveil-lance of serum calcium.