• 四川大學(xué)華西醫(yī)院內(nèi)分泌科　骨質(zhì)疏松醫(yī)療教育中心（成都，610041）;

【摘要】　目的　 評價(jià)亞洲骨質(zhì)疏松自我評價(jià)工具（OSTA）和我國婦女骨質(zhì)疏松篩選工具（OSTC）與四川地區(qū)圍絕經(jīng)期和絕經(jīng)后漢族婦女骨密度的關(guān)系，比較兩種工具對骨質(zhì)疏松癥的篩檢能力，探討其臨床應(yīng)用價(jià)值。　方法　 2010年7—10月篩選獲得356名45歲以上婦女的雙能X線骨密度儀腰椎、股骨頸和全髖骨密度數(shù)據(jù)，利用體重和年齡分別計(jì)算OSTA指數(shù)與OSTC指數(shù)，并進(jìn)行比較。　結(jié)果　 OSTA指數(shù)與OSTC指數(shù)和各部位骨密度值均呈正相關(guān)（r=0.458~0.593和r=0.440~0.599，P lt;0.001），兩種篩選指數(shù)之間呈正相關(guān)（r=0.956，P lt;0.001）。按兩級危險(xiǎn)程度分類界值進(jìn)行判定，OSTA和OSTC的靈敏度分別為78.2%、93.5%，特異度為67.2%、43.0%，受試者工作特征曲線下面積為0.792、0.798，Kappa系數(shù)為0.452、0.357。　結(jié)論　 OSTA與OSTC應(yīng)用于四川地區(qū)圍絕經(jīng)期和絕經(jīng)后婦女骨質(zhì)疏松癥的篩查效果均不理想，臨床應(yīng)用價(jià)值受限。
【Abstract】　Objective　 To evaluate the relationship between osteoporosis self-assessment tool for asians (OSTA), osteoporosis self-assessment tool for Asians (OSTC) and bone mineral density in Sichuan perimenopausal and postmenopausal women of Han nationality, and discuss the value of their clinical application through comparison of the screening ability of the two tools in predicting osteoporosis and low bone mass. 　Methods　 With the data of bone mineral density at lumbar spine, femoral neck and total proximal femur measured by DXA of 356 women aged 45 years old and above, OSTA and OSTC risk indexes of each subject were calculated based on their weight and age, and were then compared. 　Results　 The bone mineral density of above-mentioned locations were positively correlated with OSTA and OSTC indexes (r=0.458-0.593 and r=0.440-0.599,P lt;0.001), and these two indexes were also correlated positively (r=0.956, P lt;0.001). According to the two risk levels by these cutoffs, OSTA and OSTC indexes could diagnose osteoporosis with the sensitivity of 78.2% and 93.5%, the specificity of 67.2% and 43%, the area under ROC curve of 0.792 and 0.798, and the Kappa value of 0.452 and 0.357, respectively. 　Conclusion　 Both OSTA and OSTC were not ideal tools for screening osteoporosis in perimenopausal and postmenopausal women in Sichuan province.

引用本文： 劉娜,陳德才,盧春燕,王覃,劉明,潘薇. 兩種骨質(zhì)疏松自我評價(jià)工具應(yīng)用于圍絕經(jīng)期和絕經(jīng)后婦女的篩檢效果比較. 華西醫(yī)學(xué), 2011, 26(5): 656-659. doi: 復(fù)制

1. 　Dennison E, Cole Z, Cooper C. Diagnosis and epidemiology of osteoporosis[J]. Curr Opin Rheumatol, 2005, 17(4): 456-461.
2. 　Lewiecki EM. Clinical application of bone density testing for osteoporosis[J]. Minerva Med, 2005, 96(5): 317-330.
3. 　Cadarette SM, Jaglal SB, Kreiger N, et al. Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry[J]. CMAJ, 2000, 162(9): 1289-1294.
4. 　Koh LK, Sedrine WB, Torralba TP, et al. A simple tool to identify Asian women at increased risk of osteoporosis[J]. Osteoporos Int, 2001, 12(8): 699-705.
5. 　Sedrine WB, Chevallier T, Zegels B, et al. Development and assessment of the Osteoporosis Index of Risk (OSIRIS) to facilitate selection of women for bone densitometry[J]. Gynecol Endocrinol, 2002, 16(3): 245-250.
6. 　Florent R, Frederic D, Olivier E, et al. Development and validation of the ORACLE seore to predict risk of osteoporsis[J]. Myao Clin Proc, 2004, 79(11): 1402-1408.
7. 　van Staa TP, Geusens P, Pols HA, et al. A simple clinical score for estimating the long-termrisk of fracture in patients using oral g1ucocorticoids[J]. QJM, 2005, 98(3): 191-198.
8. 　張菊英, 吳濤, 楊定焯, 等. 中國大陸地區(qū)婦女骨質(zhì)疏松篩選工具探討[J]. 中國修復(fù)重建外科雜志, 2007, 21(1): 86-89.
9. 　中華醫(yī)學(xué)會骨質(zhì)疏松和骨礦鹽疾病分會. 原發(fā)性骨質(zhì)疏松癥診療指南(討論稿)[J]. 中華全科醫(yī)師雜志, 2006, 5(8): 455-457.
10. 　陳德才, 張林, 徐梁, 等. 一家大型醫(yī)院住院患者骨質(zhì)疏松癥診治現(xiàn)狀的初步調(diào)查[J]. 中華骨質(zhì)疏松和骨礦鹽疾病雜志, 2010, 3(1): 28-33.
11. 　Nguyen TV, Center JR, Pocock NA, et al. Limited utility of clinical indices for the prediction of symptomatic fracture risk in postmenopausal women[J]. Osteoporos Int, 2004, 15(1): 49-55.
12. 　Li-Yu JT, Llamado LJ, Torralba TP. Validation of OSTA among Filipinos[J]. Osteoporos Int, 2005, 16(12): 1789-1793.
13. 　Park HM, Sedrine WB, Reginster JY. Korean experience with the OSTA risk index for osteoporosis: a validation study[J]. J Clin Densitom Fall, 2003, 6(3): 247-250.
14. 　盧春燕, 蔡云華, 陳德才. OSTA篩選圖表與雙能X線吸收法診斷骨質(zhì)疏松的一致性研究[J]. 骨質(zhì)疏松和骨礦鹽疾病基礎(chǔ)與臨床, 2004, 3(4): 207-212.
15. 　陳俊, 楊定焯, 張菊英, 等. 亞洲婦女骨質(zhì)疏松自我評價(jià)工具應(yīng)用于我國大陸地區(qū)絕經(jīng)后婦女骨質(zhì)疏松的篩檢效果評價(jià)[J]. 中國慢性病預(yù)防與控制, 2009, 17(2): 142-144.
16. 　張浩, 章振林, 黃琪仁, 等. 兩種骨質(zhì)疏松篩選方法在絕經(jīng)后骨質(zhì)疏松婦女中的應(yīng)用比較[J]. 中國骨質(zhì)疏松雜志, 2009, 15(6): 395-399.
  1. 1. 　Dennison E, Cole Z, Cooper C. Diagnosis and epidemiology of osteoporosis[J]. Curr Opin Rheumatol, 2005, 17(4): 456-461.
  2. 2. 　Lewiecki EM. Clinical application of bone density testing for osteoporosis[J]. Minerva Med, 2005, 96(5): 317-330.
  3. 3. 　Cadarette SM, Jaglal SB, Kreiger N, et al. Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry[J]. CMAJ, 2000, 162(9): 1289-1294.
  4. 4. 　Koh LK, Sedrine WB, Torralba TP, et al. A simple tool to identify Asian women at increased risk of osteoporosis[J]. Osteoporos Int, 2001, 12(8): 699-705.
  5. 5. 　Sedrine WB, Chevallier T, Zegels B, et al. Development and assessment of the Osteoporosis Index of Risk (OSIRIS) to facilitate selection of women for bone densitometry[J]. Gynecol Endocrinol, 2002, 16(3): 245-250.
  6. 6. 　Florent R, Frederic D, Olivier E, et al. Development and validation of the ORACLE seore to predict risk of osteoporsis[J]. Myao Clin Proc, 2004, 79(11): 1402-1408.
  7. 7. 　van Staa TP, Geusens P, Pols HA, et al. A simple clinical score for estimating the long-termrisk of fracture in patients using oral g1ucocorticoids[J]. QJM, 2005, 98(3): 191-198.
  8. 8. 　張菊英, 吳濤, 楊定焯, 等. 中國大陸地區(qū)婦女骨質(zhì)疏松篩選工具探討[J]. 中國修復(fù)重建外科雜志, 2007, 21(1): 86-89.
  9. 9. 　中華醫(yī)學(xué)會骨質(zhì)疏松和骨礦鹽疾病分會. 原發(fā)性骨質(zhì)疏松癥診療指南(討論稿)[J]. 中華全科醫(yī)師雜志, 2006, 5(8): 455-457.
  10. 10. 　陳德才, 張林, 徐梁, 等. 一家大型醫(yī)院住院患者骨質(zhì)疏松癥診治現(xiàn)狀的初步調(diào)查[J]. 中華骨質(zhì)疏松和骨礦鹽疾病雜志, 2010, 3(1): 28-33.
  11. 11. 　Nguyen TV, Center JR, Pocock NA, et al. Limited utility of clinical indices for the prediction of symptomatic fracture risk in postmenopausal women[J]. Osteoporos Int, 2004, 15(1): 49-55.
  12. 12. 　Li-Yu JT, Llamado LJ, Torralba TP. Validation of OSTA among Filipinos[J]. Osteoporos Int, 2005, 16(12): 1789-1793.
  13. 13. 　Park HM, Sedrine WB, Reginster JY. Korean experience with the OSTA risk index for osteoporosis: a validation study[J]. J Clin Densitom Fall, 2003, 6(3): 247-250.
  14. 14. 　盧春燕, 蔡云華, 陳德才. OSTA篩選圖表與雙能X線吸收法診斷骨質(zhì)疏松的一致性研究[J]. 骨質(zhì)疏松和骨礦鹽疾病基礎(chǔ)與臨床, 2004, 3(4): 207-212.
  15. 15. 　陳俊, 楊定焯, 張菊英, 等. 亞洲婦女骨質(zhì)疏松自我評價(jià)工具應(yīng)用于我國大陸地區(qū)絕經(jīng)后婦女骨質(zhì)疏松的篩檢效果評價(jià)[J]. 中國慢性病預(yù)防與控制, 2009, 17(2): 142-144.
  16. 16. 　張浩, 章振林, 黃琪仁, 等. 兩種骨質(zhì)疏松篩選方法在絕經(jīng)后骨質(zhì)疏松婦女中的應(yīng)用比較[J]. 中國骨質(zhì)疏松雜志, 2009, 15(6): 395-399.