亚洲骨质疏松筛查工具在健康体检中的筛查准确性评价及适宜切点研究

doi:10.19723/j.issn.1671-167X.2019.06.019

摘要/Abstract

摘要：

目的探索亚洲骨质疏松筛查工具(osteoporosis self-assessment tool for Asians, OSTA)在中国健康体检人群中的筛查价值,探索适宜中国健康体检人群的最佳切点值。方法选取2013—2016年在北京大学第三医院体检中心进行骨密度筛查的体检人群作为研究对象,定量超声骨密度检测(quantitative ultrasound, QUS)结果T值≤-2.5者定义为骨质疏松症患者。分析OSTA在不同切点时的灵敏度、特异度、似然比和曲线下面积(area under curve,AUC),比较不同切点时OSTA的筛查准确性,寻找适宜的切点值。结果共纳入研究对象5 833名,平均年龄(48.3±17.5)岁,其中女性2 594人(占44.5%)。QUS检测结果显示骨质疏松患者403人(占总人群6.9%),女性患者343人(占女性人群13.22%)。在全年龄组人群中,OSTA国际常规切点值(≤-1)筛查骨质疏松的AUC为0.815(95%CI:0.804~0.825),女性人群筛查准确性(AUC=0.837,95%CI:0.823~0.851)优于男性人群(AUC=0.767,95%CI:0.752~0.781;P<0.05)。在全年龄组人群中以OSTA≤0为筛查切点值筛查骨质疏松的AUC为0.842(95%CI:0.832~0.851),准确性优于以-1为切点值(P<0.01),净重分类指数(net reclassification improvement,NRI)提高5.5%。40~65岁人群中,以OSTA≤0为筛查切点值时,筛查准确性较-1时提高明显(NRI=19.5%,P=0.003)。结论 OSTA筛查工具在健康体检人群中具有较好的骨质疏松筛查价值,且女性人群的筛查准确性优于男性,适度提高OSTA的筛查切点值能够在全年龄组人群和40~65岁年龄组人群中有更好的筛查获益。

关键词: 亚洲骨质疏松筛查工具, 骨密度, 健康调查, 敏感性与特异性

Abstract:

Objective: To explore the screening value of osteoporosis self-assessment tool for Asians (OSTA) and the optimal cut-off value in Chinese healthy physical examination population.Methods: We selected a healthy physical examination population for bone mineral density screening at the Health Examination Center in Peking University Third Hospital from 2013 to 2016. Quantitative ultrasound (QUS) results were used as the gold standard, and T value ≤-2.5 was defined as osteoporosis patients. Diagnostic test methods were used to analyze the sensitivity, specificity, likelihood ratio and area under curve (AUC) of different cut points of OSTA. The screening accuracy of OSTA at different cut points was compared and the optimal cut-point value determined.Results: A total of 5 833 subjects were included in the study, with an average age of (48.3±17.5) years and 2 594 women (44.5%). The QUS test showed 403 patients with osteoporosis (6.9% of the total population), 343 female osteoporosis patients (13.22% of the female population). In the whole age group, AUC at the international routine cut-off value (OSTA ≤-1) screening for osteoporosis was 0.815 (95%CI: 0.804-0.825), and screening accuracy was higher in the women (AUC=0.837, 95%CI: 0.823-0.851) than that in the men (AUC=0.767, 95%CI: 0.752-0.781; P<0.05). In the whole age group, when the optimal cut-off value was 0, its AUC 0.842 (95%CI: 0.832-0.851) was significantly higher than that when the cut-off value was -1 (P<0.01), and net reclassification improvement (NRI) increased by 5.5%. In the 40 to 65-year-old group, when OSTA cut-off value ≤0, the screening accuracy was significantly higher (NRI=19.5%, P=0.003) than that when it was-1.Conclusion: The OSTA screening tool had good osteoporosis screening value in healthy people, and the screening accuracy in women is higher than that in men. Increasing the screening cut-off value of OSTA would be helpful to improve the screening accuracy in the whole and 40 to 65-year-old population. There may be different optimal cut-off values for different age group population.

Key words: Osteoporosis self-assessment tool for Asians, Bone density, Health surveys, Sensitivity and specificity

中图分类号:

R681

王鹏,吴华,车颖,范东伟,刘珏,陶立元. 亚洲骨质疏松筛查工具在健康体检中的筛查准确性评价及适宜切点研究[J]. 北京大学学报（医学版）, 2019, 51(6): 1085-1090.

Peng WANG,Hua WU,Ying CHE,Dong-wei FAN,Jue LIU,Li-yuan TAO. Evaluation of screening accuracy on osteoporosis self-assessment tool for Asians and its cut-off value in healthy physical examination population[J]. Journal of Peking University(Health Sciences), 2019, 51(6): 1085-1090.

图/表 4

表1

研究对象的基本情况"

Items	All	Non-osteoporosis	Osteoporosis	t/χ²	P value
Participants, n (%)	5 833	5 430 (93.09)	403 (6.91)
Age/years, $x ?$ ±s	48.32±17.53	46.42±16.40	74.02±10.70	33.26	<0.001
Age group, n (%)				1 111.43	<0.001
<40 years	2 398 (41.11)	2 390 (44.01)	8 (1.99)
40-65 years	2 274 (38.99)	2 216 (40.81)	58 (14.39)
≥65 years	1 161 (19.90)	824 (15.18)	337 (83.62)
Gender, n (%)				289.55	<0.001
Female	2 594 (44.47)	2 251 (41.45)	343 (85.11)
Male	3 239 (55.53)	3 179 (58.55)	60 (14.89)
Height/cm, $x ?$ ±s	166.44±8.26	167.11±7.99	157.39±6.32	23.89	<0.001
Weight/kg, $x ?$ ±s	67.34±13.20	67.86±13.23	60.26±10.40	11.28	<0.001
BMI/(kg/m²), $x ?$ ±s	24.17±3.60	24.17±3.62	24.26±3.45	0.47	0.638

表1

表2

图1

表3

参考文献 28

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Items	Osteoporosis,n (%)	Sensitivity/%	Specificity/%	+LR	-LR	AUC (95%CI)
All age group
All	403 (6.9)	73.95	88.99	6.71	0.29	0.815 (0.804-0.825)
Male	60 (1.9)	66.67	86.66	5.00	0.38	0.767 (0.752-0.781)
Female	343 (13.2)	75.22	92.27	9.73	0.27	0.837 (0.823-0.851)
More than 40-year-old
All	395 (11.5)	75.44	80.33	3.84	0.31	0.779 (0.753-0.805)
Male	58 (3.1)	68.96	77.12	3.01	0.40	0.730 (0.661-0.800)
Female	337 (22.11)	76.56	85.35	5.23	0.27	0.809 (0.781-0.838)

Items	AUC	SE	95%CI	Z	P₁	NRI	P₂
All age group
OSTA ≤-1	0.815	0.011	0.804-0.825	Ref.	Ref.
OSTA ≤ 0	0.842	0.010	0.832-0.851	3.692	<0.001	0.055	<0.001
OSTA ≤ 0.62	0.850	0.009	0.841-0.859	4.048	<0.001	0.071	<0.001
40 to 65-year-old
OSTA ≤-1	0.572	0.025	0.551-0.592	Ref.	Ref.
OSTA ≤ 0	0.669	0.033	0.649-0.689	3.428	<0.001	0.195	0.003
OSTA ≤ 0.62	0.724	0.033	0.706-0.743	4.693	<0.001	0.305	<0.001
More than 40-year-old
OSTA ≤-1	0.779	0.011	0.765-0.793	Ref.	Ref.
OSTA ≤ 0	0.792	0.010	0.778-0.805	1.637	0.102	0.025	0.126
OSTA ≤ 0.62	0.790	0.009	0.776-0.803	1.153	0.249	0.021	0.293