摘要
目的 基于双能X线吸收仪(Dualenergy X-ray absorptiometry,DXA)相关参数分析绝经期类风湿性关节炎继发骨质疏松症的危险因素,并构建绝经期类风湿性关节炎继发骨质疏松症的风险列线图。方法 回顾性分析自2021-12—2023-11青海省中医院收治的166例绝经期类风湿性关节炎患者,根据患者继发骨质疏松症情况,将其分为继发组(76例)和非继发组(90例),比较两组一般资料、临床特征及DXA相关参数,分析绝经期类风湿性关节炎继发骨质疏松症的独立影响因素,并运用Rstudio 4.2.1软件构建患者继发骨质疏松症的风险列线图模型,采用Hosmer-Lemeshow验证模型的拟合度。结果 多因素Logistic回归分析结果显示,年龄(95%CI=1.260~1.883,P<0.001)、RA病程(95%CI=1.310~3.472,P=0.002)、髋关节骨密度(95%CI=0.001~0.023,P=0.001)、股骨颈骨密度(95%CI=0.001~0.489,P=0.024)、腰椎骨密度(95%CI=0.004~0.901,P=0.042)及骨矿含量(95%CI=0.098~0.502,P<0.001)均是绝经期类风湿性关节炎继发骨质疏松症的独立影响因素(P<0.05)。基于以上因素构建的骨质疏松症风险列线图,ROC曲线下积(AUC)为0.976(95%CI为0.958~0.995),最大Youden指数为0.891,敏感度为0.947,特异度为0.944,对患者术后继发骨质疏松症风险有较好的预测价值。采用Hosmer-Lemeshow检验构建的列线图的拟合程度,最终模型H-L检验χ^(2)=7.385,P=0.496,拟合度较好。结论 年龄、类风湿性关节炎病程、髋关节骨密度、股骨颈骨密度、腰椎骨密度及骨矿含量均是绝经期类风湿性关节炎继发骨质疏松症的独立影响因素,依此所构建的列线图模型能够较为准确地预测绝经期类风湿性关节炎继发骨质疏松症的风险,具有一定的临床意义。
Objective To analyze the risk factors for secondary osteoporosis in menopausal rheumatoid arthritis based on the relevant parameters of Dual Energy X-ray absorptiometry(DXA),and construct a risk column chart for secondary osteoporosis in menopausal rheumatoid arthritis.Methods A retrospective analysis was conducted on 166 patients with menopausal rheumatoid arthritis admitted to Qinghai Provincial Traditional Chinese Medicine Hospital from December 2021 to November 2023.Based on the secondary osteoporosis status of the patients,they were divided into a secondary group(76 cases) and a non secondary group(90 cases).The general information,clinical characteristics,and DXA related parameters of the two groups were compared to analyze the independent influencing factors of secondary osteoporosis in menopausal rheumatoid arthritis.A risk column chart model for secondary osteoporosis in patients was constructed using Rstudio 4.2.1 software,and Hosmer Lemeshow was used to verify the fit of the model.Results The results of multiple logistic regression analysis showed that age(95%CI=1.260-1.883,P<0.001),duration of rheumatoid arthritis(95%CI=1.310-3.472,P=0.002),hip joint bone density(95%CI=0.001-0.023,P=0.001),femoral neck bone density(95%CI=0.001-0.489,P=0.024),lumbar spine bone density(95%CI=0.004-0.901,P=0.042),and bone mineral content(95%CI=0.098-0.502,P<0.001) were all independent influencing factors of secondary osteoporosis in menopausal rheumatoid arthritis(P<0.05).The osteoporosis risk column chart constructed based on the above factors had a lower product of the ROC curve(AUC) of 0.976(95%CI=0.958-0.995),a maximum Youden index of 0.891,a sensitivity of 0.947,and a specificity of 0.944.It had good predictive value for the risk of postoperative secondary osteoporosis in patients.The fitting degree of the column chart constructed using Hosmer Lemeshow test was tested,and the final model H-L test had a chi square of 7.385,P=0.496,indicating good fitting degree.Conclusion Age,duration of rheumatoid arthritis,hip joint bone density,femoral neck bone density,lumbar spine bone density,and bone mineral content are all independent risk factors of secondary osteoporosis in menopausal rheumatoid arthritis.The column chart model constructed based on this can accurately predict the risk of secondary osteoporosis in menopausal rheumatoid arthritis and has certain clinical significance.
作者
王燕彬
方靖
刘有云
王建辉
祁生平
李作瑞
杨富艳
畅旭东
韩琼
WANG Yanbin;FANG Jing;LIU Youyun;WANG Jianhui;QI Shengping;LI Zuorui;YANG Fuyan;CHANG Xudong;HAN Qiong(Radiology Department of Qinghai Provincial Hospital of Traditional Chinese Medicine,Xining,Qinghai 810000,China)
出处
《中国骨与关节损伤杂志》
2024年第12期1259-1264,共6页
Chinese Journal of Bone and Joint Injury
基金
青海省卫生健康委指导性科研项目(2022-wjzdx-23)。
