初步探讨超声测量BMD、FRAX~?和OSTA评定维持性血液透析患者骨折风险

Ultrasonic measurement of BMD,FRAX~? and OSTA in the prediction of fracture risk in maintenance hemodialysis

目的评价及比较超声测量骨密度(BMD)、FRAX~?(不含BMD模型)和OSTA工具对维持性血液透析(MHD)患者骨折风险的预测作用。方法收集2013年1月至2015年1月之间于南充市中心医院血液净化中心进行规律血液透析的113例患者的一般资料、各种骨质疏松的临床危险因子和桡骨远端1/3处超声BMD数据;采用FRAX~?和OSTA工具分别计算M H D患者骨折风险概率;并绘制ROC曲线,比较超声测量BM D、FRAX~?和OSTA评定MHD患者骨折风险的有效性。结果参与骨折风险预测的MHD患者共113例,女63例(55.75%),男5 0例(4 4.2 5%),患者年龄1 3~8 3岁,平均年龄为(5 6.6±1 6.0)岁。其中骨折组1 4人(12.39%),未骨折的99人(87.61%),骨折组的平均BMD为-3.69±2.32,未骨折组为-2.0 9±1.9 1,骨折组的BM D低于未骨折组,差异有统计学意义(P<0.0 5)。FRAX~?指数在未骨折组和骨折组的比较中显示(z=-4.837,P<0.01),两者差异有统计学意义。骨折组的OSTA平均评分为-3.6 9±2.7 6,未骨折组为0.4 6±3.6 0,2组间结果比较显示差异有统计学意义(P<0.05)。超声测量BMD、FRAX~?和OSTA预测患者骨折风险的ROC曲线下面积分别为:0.6 8 8(9 5%CI 0.5 3 4~0.8 4 2);0.9 0 0(9 5%CI 0.8 1 6~0.9 8 4);0.8 6 8(9 5%CI 0.7 9 3~0.9 4 2)。超声测量BM D、FRAX~?和OSTA的cut-off值分别为:-2.45,3.25,-2.93。结论超声测量BMD、FRAX~?(不含BMD模型)和OSTA均能初步评定MHD患者的骨折风险,其中FRAX~?有效性最高。

Objective To evaluate and compare the validity of quantitative ultrasound bone measurements （QUS） to measure the bone mineral density （BMD）, FRAX and OSTA for predicting fracture risk in maintenance hemodialysis （MHD） patients. Methods 113 patients from the Blood Purification Center of Nanchong Central Hospital from January 2013 to January 2015 were fitted in this study. The demographic information, clinical risk factors of osteoporosis, and the data of BMD from one third of distal radius about the MHD patients were collected. The probability of fracture risk in MHD patients was calculated by FRAX and OSTA. ROC curves were drawn. The validity of BMD, FRAX and OSTA for predicting fracture risk in MHD patients was compared. Results 113 patients were fitted in predicting fracture risk. There were 63 females and 50 males with age ranging 13 - 83 years （mean 56.6 ± 16.0 years）. The fracture group had 14 （12.39%） patients, and the control group had 99 （87.61%） patients. The average BMD in the fracture group and control group was - 3.69 ± 2.32 and - 2.09 ±1.91 respectively （P〈0.05）. The FRAX index showed significant difference between the two groups （z = - 4. 837, P〈0.01）. The average score in the fracture group and control group was - 3.69 ＋ 2.76 and 0.46 ＋ 3.60 respectively （P〈0.05）. AUC areas of ROC curves of BMD, FRAX and OSTA were 0. 688 （95% CI 0.534 - 0. 842）; 0. 900 （95% CI 0.816 - 0.984; 0.868 （95% CI 0.793 - 0.942）, respectively. The cutoff values of BMD, FRAX and OSTA were - 2.45, 3.25 and - 2.93 respectively. Conclusions All of BMD, FRAX and OSTA may discriminate fracture risk among MHD patients and FRAX had the higher validity.