天津医药

天津医药 ›› 2024, Vol. 52 ›› Issue (7): 766-769.doi: 10.11958/20231883

• 临床研究 • 上一篇    下一篇

骨质疏松症患者腰椎骨折预测模型的构建

王敏1,2(), 王龙胜1,2,∆(), 陈磊3   

  1. 1 安徽医科大学第二附属医院放射科（邮编230601）
    2 安徽医科大学医学影像研究中心
    3 安徽医科大学第二附属医院骨科
  • 收稿日期:2023-12-04 修回日期:2024-03-07 出版日期:2024-07-15 发布日期:2024-07-11
  • 通讯作者: ∆E-mail：wanglongsheng@ahmu.edu.cn
  • 作者简介:王敏（1986），男，主管技师，主要从事CT、MRI成像技术与图像质量控制方面研究。E-mail：492257926@qq.com

Construction of a prediction model for lumbar fracture in patients with osteoporosis

WANG Min1,2(), WANG Longsheng1,2,∆(), CHEN Lei3   

  1. 1 Department of Radiology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
    2 Medical Imaging Research Center, Anhui Medical University
    3 Department of Orthopaedics, the Second Affiliated Hospital of Anhui Medical University
  • Received:2023-12-04 Revised:2024-03-07 Published:2024-07-15 Online:2024-07-11
  • Contact: ∆E-mail：wanglongsheng@ahmu.edu.cn

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摘要：

目的 基于腰椎定量CT（QCT）骨密度值和骨代谢指标构建骨质疏松症（OP）患者发生腰椎骨折的预测模型。方法 以骨质疏松性腰椎骨折患者52例（骨折组）和OP患者104例（未骨折组）为研究对象，分析骨折组腰椎QCT骨密度值与血清Ⅰ型原胶原C-端前肽（P1CP）、骨钙素N端中分子片段（N-MID）及β-胶联降解产物（β-CTX）指标间的相关性，Logistic回归分析患者腰椎骨折发生的影响因素，构建预测模型并分析其预测价值。结果 与未骨折组比较，骨折组的女性、跌倒史占比高，β-CTX水平高，维生素D/钙剂用药史占比、腰椎QCT骨密度值、P1CP、N-MID水平低（P<0.05）。Pearson相关分析显示，骨折患者腰椎QCT骨密度值与血清P1CP、N-MID呈正相关，与β-CTX呈负相关（r分别为0.523、0.506、-0.536，P<0.05）。多因素Logistic回归分析显示，较高水平的腰椎QCT骨密度值、P1CP、N-MID及维生素D/钙剂用药史是腰椎骨折发生的保护因素，较高水平β-CTX是危险因素（P<0.05）。构建的预测模型预测腰椎骨折的敏感度为84.62%，特异度为97.12%，曲线下面积为0.926（95%CI：0.873~0.962）。预测模型的校准度良好，一致率为0.910。结论 较高水平的腰椎QCT骨密度值、P1CP、N-MID及低水平β-CTX的OP患者腰椎骨折风险较低，使用维生素D及钙剂可有效预防OP患者，尤其女性腰椎骨折的发生。

关键词: 骨质疏松, 骨密度, 危险因素, Logistic模型, 腰椎骨折, 骨代谢

Abstract:

Objective To construct a prediction model for lumbar fracture in patients with osteoporosis (OP) based on lumbar bone mineral density measured by quantitative computed tomography (QCT) and bone metabolism indicators. Methods A total of 52 patients with OP and lumbar fracture (the fracture group) and 104 patients with OP without lumbar fracture (the non-fracture group) were selected as study subjects. The correlation between lumbar bone mineral density measured by QCT and serum procollagen type I C-propeptide (P1CP), N-terminal mid-fragment of osteocalcin (N-MID) and beta collagen degradation products (β-CTX) was analyzed. Logistic regression analysis was conducted to identify influencing factors of lumbar fracture. A prediction model was constructed and its predictive value was analyzed. Results Compared with the non-fracture group, the proportions of females and patients with fall history, β-CTX level and vitamin D/ calcium medication history were higher in the fracture group, and lumbar bone mineral density measured by lumbar QCT, P1CP and N-MID levels were lower (P<0.05). Pearson correlation analysis found that lumbar bone mineral density measured by QCT was positively correlated with serum levels of P1CP and N-MID, and negatively correlated with β-CTX (r=0.523, 0.506, -0.536, P<0.05). Multivariate Logistic regression analysis found that higher lumbar bone mineral density measured by QCT, P1CP, N-MID and history of taking vitamin D/calcium were protective factors for lumbar fracture, and igher β-CTX level was a risk factor (P<0.05). The sensitivity and specificity of the prediction model constructed based on Logistic regression analysis results for predicting lumbar fracture were 84.62% and 97.12%. The area under the curve was 0.926 (95%CI: 0.873-0.962). The prediction model had good calibration, and the agreement rate was 0.910. Conclusion OP patients with higher levels of QCT, P1CP and N-MID, and lower level of β-CTX have lower risk of lumbar fracture. Vitamin D and calcium can effectively prevent the occurrence of lumbar fracture in OP patients, especially in women.

Key words: osteoporosis, bonedensity, risk factors, Logistic models, lumbar fracture, bone metabolism

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