老年骨质疏松患者风险预警监控系统的构建和应用

Establishment and application of risk warning and monitoring system for elderly patients with osteoporosis

目的探讨老年骨质疏松患者风险预警监控系统的构建和应用效果。方法随机纳入2018年1月至2020年1月收治的60例老年骨质疏松患者,记录患者年龄、性别、骨密度、BMI、既往脆性骨折史、父母髋部骨折史、抽烟、过量喝酒、合并其他疾病史、服用药物史、血酸性磷酸酶水平危险因素11项,构建风险预警监控评分系统,随访2年,观察在不同的评分条件下,患者出现骨折的风险,使用ROC曲线风险预警系统的预测价值进行评估,获取最佳风险系数。结果随访1年,60例患者中预后良好41例(68.33%),风险预警监控系统评分为(30.21±5.12)分,其中11~33分占32例;19例(31.67%)预后不良,风险预警监控系统评分为(40.85±5.74)分,其中11~33分占4例;组间比较差异均有统计学意义(均P<0.05)。根据ROC曲线评价模型的风险预测不良预后的价值,AUC为0.880(95%CI:0.856-0.905),最佳截断值为6.331分,敏感性为79.9%,特异性为82.7%,模型的预测价值好。结论风险预警监控系统对老年骨质疏松患者出现骨折等不良预后具有一定的预测价值,对指导临床及时干预和改善患者预后等均具有重要的临床意义。

Objective To explore the establishment and application effect of risk early warning and monitoring system for elderly patients with osteoporosis.Methods 60 patients with senile osteoporosis were randomly selected from January 2018 to January 2020.11 risk factors(age,gender,bone mineral density,BMI,history of fragility fracture,parents'history of hip fracture,smoking,excessive drinking,history of merging other diseases,medication history,blood acid phosphatase)of the patients were recorded,the scoring system of risk early warning and monitoring was established.All patients were followed up for 1 year,the risk of fracture of patients was observed under the condition of different grade.The predictive value of risk early warning and monitoring system was evaluated with the ROC curve,and the best risk coefficient was obtained.Results After a year of follow-up,41 cases(68.33%)of the 60 patients had good prognosis,and the score of risk warning and monitoring system was(30.21±5.12)points,among whom there were 32 cases of 11-33 points.19 cases(31.67%)had poor prognosis,and the score of risk warning and monitoring system was(40.85±5.74)points,among whom there were 4 cases of 11-33 points.There were statistically significant differences between the two groups(all P<0.05).According to the ROC curve,the value of risk prediction for poor prognosis of the model was 0.880(95%CI:0.856-0.905),the best cutoff value was 6.331 points,with the sensibility of 79.9%and the specificity of 82.7%.Conclusion Risk early warning and monitoring system has a certain predictive value for fracture and other poor prognosis in elderly patients with osteoporosis,and is of great clinical significance for guiding timely clinical intervention and improving prognosis of patients.