基于SMOTE算法和决策树的绝经后骨质疏松性骨折分类模型建构

目的构建符合北京、上海两地40～65岁女性人口学特征的危险因素和中医症状相结合的骨质疏松性骨折早期风险预测工具。方法本研究采用注册登记式研究的方法 ,于2009年3-8月在北京市东城区及上海市徐汇区收集的1 823例40～65岁女性骨质疏松症高危人群的危险因素及中医症状信息,进行连续3年的登记观察。采用SMOTE过抽样算法平衡数据,基于决策树模型筛选与骨质疏松症骨折有关的危险因素及中医症状,并建立骨质疏松性骨折风险评估工具。结果本研究选择C4.5算法作为预测模型建立工具。首先筛选出对绝经后骨质疏松性骨折高危患者发生脆性骨折的危险因素,然后建立预测模型。由于样本量较小,在节点的设置中采用交叉验证,Mode选用Expert,修剪纯度设为75,采用全局修剪。根据此生长和修剪规则,所建立分类树模型共包括5层,共19个结点,共筛选出6个解释变量。各指标按重要程度从大到小依次为骨密度、目眩、肉类、生产次数、视物模糊和乏力。经过逐层各影响因素的分类,最终骨折人群比例占13%。对该预测模型预测概率绘制受试者工作特征曲线,结果显示曲线下面积为0.871(95%CI=0.8226-0.9211)。结论初步建立了基于北京、上海人口学特征40～65岁女性骨质疏松性骨折分类模型。     

中国苏州地区老年女性中骨质疏松症危险因素的筛选

目的筛选与评估骨质疏松症的相关危险因素,为骨质疏松症的防治提供依据。方法选择3 915名苏州地区绝经后妇女,基于亚洲人骨质疏松自我筛查工具(osteoporosis self-assessment tool for asians,OSTA)指数将人群分为骨质疏松(osteoporosis, OP)低风险组(-1)、中风险组(-1～-4)和高风险组(-4),对其饮食习惯及女性健康史进行问卷调查。结果怀孕次数、累计母乳喂养时间、绝经年龄、月经持续年限、茶、经常吃的肉的种类、最近一周吃油炸食品的数量、绝经类型、是否子宫切除组间差异有统计学意义(P0.05),上述变量是OP相关的危险因素。由有序Logistic回归分析结果显示,怀孕次数、绝经年龄、经常喝茶、绝经类型等与OP风险显著相关(P0.05),而且怀孕次数与哺乳时间存在交互作用。结论苏州地区老年绝经女性的月经史、怀孕史、饮食习惯等都是骨质疏松的重要风险因素。     

BMD、OSTA与FRAX®预测绝经后女性骨质疏松性 骨折风险的比较研究

目的比较BMD、OSTA与FRAX(不含BMD模型)预测绝经后女性骨质疏松性骨折风险的准确性,为选择适合我国绝经后女性骨质疏松性骨折风险工具提供研究依据。方法 2011年1月至2011年12月,以首都医科大学附属北京友谊医院就诊并接受DXA骨密度检查的绝经后女性为研究对象,连续纳入1497例,建立队列。基于基线数据,以就诊时发生骨质疏松性骨折与否为参考标准,绘制ROC曲线,比较BMD、OSTA及FRAX评分预测骨质疏松骨折发生风险的准确性。结果发生骨折组(n=343)患者的BMD,OSTA评分与FRAX评分均低于未发生骨折组(n=1154),且差异均有统计学意义。BMD、OSTA及FRAX评分(不使用骨密度的主要部位FRAX评分)预测骨折风险的ROC曲线下面积分别为0.654(95%CI:0.621-0.687),0.629(95%CI:0.595-0.663)和0.907(95%CI:0.888-0.926),最佳诊断截点值分别为-1.25,-1.90和3.65%。结论不使用骨密度的主要部位FRAX评分可用于我国绝经后女性的骨质疏松性骨折风险评估,但诊断截点值为3.65%,远低于WHO推荐的20%,其原因需要进一步研究。     

血清羧化不全骨钙素对绝经后女性骨质疏松症诊疗意义的探讨

目的检测绝经后女性血清羧化不全骨钙素(ucOC)的水平,并探讨其影响因素及其对绝经后女性骨质疏松症诊疗的意义。方法选择南京医科大学附属南京医院2015年07月至2016年12月在骨科门诊就诊的绝经后女性患者108例,依据骨密度检查将这些患者分为骨质疏松组与非骨质疏松组;记录其年龄、身高、体重、体重指数(BMI)、绝经年龄、骨密度(BMD)等相关资料;抽取外周血测定碱性磷酸酶(ALP)、血钙、血磷、羧化不全骨钙素(ucOC)的水平,并对上述资料进行相关的统计学分析。结果绝经后女性骨质疏松组患者的血清ucOC水平与非骨质疏松组相比差异有统计学意义(P0.05);血清ucOC水平是骨质疏松症的影响因素(OR=2.806,P0.05)。(2)血清ucOC水平与腰椎骨密度呈负相关(r=-0.395,P0.05),但与髋关节骨密度无显著相关性(r=-0.248,P0.05)。结论血清ucOC水平的变化与绝经后女性骨质疏松症的发生关系密切,血清高ucOC水平是绝经后女性骨质疏松症发生的危险因素;推断血清ucOC水平对于绝经后女性骨质疏松症早期的预测和筛查具有参考意义     

骨质疏松性骨折的危险因素及中医证候要素风险评估研究现状

骨质疏松性骨折是骨质疏松症最具破坏性的结局,多个相互作用的危险因素对其发生有一定的影响。人在40岁之后,随着年龄的增长,身体的机能开始逐渐衰退,开始出现如腰酸、背痛、下肢抽筋、乏力等症状,这些症状与肾虚、肝虚、脾虚、血瘀等中医证候要素之间存在一定的关联性,而这些症状的出现可能对骨折的发生有一定的早期提示作用。现有的骨质疏松性骨折风险评估工具多是基于现代医学危险因素开发而成,缺乏骨质疏松性骨折证候学方面的研究内容,在实际应用中存在一定的局限。如果在预测工具中融入中医证候的相关研究内容,建立符合我国人口学特征的骨质疏松性骨折风险评估模型,必将有助于提高风险评估工具对骨质疏松性骨折高危人群的风险评估准确性。     

原发性骨质疏松症易患人群髋部骨密度多因素分析

目的利用双能量X线骨密度仪（DXA）对原发性骨质疏松症的易患人群进行髋部骨密度测定，进行回顾性调查，筛选出常见的原发性骨质疏松危险因子，并探讨其与骨质疏松发病的关系。方法用DXA对542名受检者进行左髋部骨密度（BMD）检查测定，所有的受检人员均进行问卷调查，包括：一般状况、生活习惯、健康状况和药物治疗等情况。将所采集的数据进行计算机编码输入SPSS数据库统计软件中作多因素分析，根据WHO的标准将结果分为两类，即非骨质疏松（T〉-2．5）和骨质疏松（r≤-2．5），男性的危险因子为年龄，体重身高比，长期饮酒，吸烟，不锻炼。女性的危险因子为年龄，体重身高比，初潮年龄，已绝经时间，首胎年龄，分娩次数，不锻炼。结果在542人中，男女性髋部的BMD在55岁以上就开始有显著性差异。用SPSS软件分析不同性别髋部BMD与年龄的相关性，结果显示男性髋部、女性髋部的平均BMD值与年龄分别均具有统计学意义（P〈0．01）的负相关性，相关系数r分别为-0．401、-0．548，可见女性的髋部BMD与年龄的相关性更高一些。用SPSS统计软件进行logistic回归分析，在男性髋部为年龄，在女性髋部为已绝经时间。结论高龄为老年男性髋部骨质疏松的主要危险因子，较长的绝经后时间为老年女性髋部骨质疏松的主要危险因子。     

绝经后女性骨质疏松性椎体骨折与腰椎体骨密度的相关性

随着我国步入老龄化社会,骨质疏松症的患病率明显升高。骨质疏松症最严重的危害来自骨质疏松性骨折,绝经后女性尤其多见。由于脊柱独特的解剖学和生物力学特点,骨质疏松患者更易发生椎体骨折。骨密度测量是诊断骨质疏松的金标准。本文通过回顾近年来相关文献,探讨腰椎体骨密度检测对绝经后女性骨质疏松性椎体骨折的意义,发现:绝经后骨质疏松性椎体骨折患者的BMD水平比绝经后骨质疏松症但无脊椎骨折者明显减少;绝经后骨质疏松症患者的BMD水平越低,其发生椎体骨折的风险越高;有椎体骨折史的绝经后骨质疏松症患者的BMD水平与发生再次椎体骨折的风险呈负相关。药物干预通常可明显提高绝经后骨质疏松症患者的BMD水平,同时还可减少椎体骨折的发生。尚存在一些不足:腰椎骨密度可能出现假性增高;需进一步探讨预测骨质疏松性椎体骨折的骨密度阈值;药物干预的研究中BMD水平与椎体骨折发生的相关性并没有得到深入研究;缺少大规模的绝经后骨质疏松性椎体骨折的流行病学,现有研究也大都存在病例收集方法不规范、样本量小、年龄分布存在差异等不足。对绝经后骨质疏松性椎体骨折的深入研究需要多学科共同协作。     

IL-33与绝经后骨质疏松女性骨密度和骨代谢指标相关性研究

目的 探索血清白细胞介素-33(IL-33)与绝经后骨质疏松女性骨密度和骨代谢指标相关性。方法 采用酶联免疫吸附法测定50例绝经后骨质疏松患者和50例正常绝经后妇女血清IL-33水平。采用双能X线骨密度仪(DXA)测量患者和对照组的骨密度(BMD)。检测维生素D、钙、碱性磷酸酶(ALP)、甲状旁腺激素(PTH)水平,以及1型胶原C末端肽(CTX)和1型前胶原N端前肽(P1NP)等骨转换指标。结果 在绝经后骨质疏松症女性中,IL-33水平显著低于健康对照组[(3.53±2.45) pg/mL vs (13.72±5.39) pg/mL,P=0.007];Spearman相关分析表明血清IL-33水平与年龄、BMI、PTH、CTX和P1NP水平呈负相关,与腰椎BMD和股骨颈BMD呈正相关。多元回归分析表明,年龄、BMI、腰椎BMD、PTH、股骨颈BMD和血清CTX和P1NP水平是骨质疏松症患者血清IL-33水平降低的独立预测因子。结论 血清IL-33降低是绝经后骨质疏松患者股骨颈和腰椎骨密度降低和骨转换增速的危险因素。     

绝经后骨质疏松症患者骨折危险因素的Logistic回归分析

目的分析绝经后骨质疏松症患者骨折的危险因素。方法选择自2009-05—2012-12诊治的绝经后妇女105例,分为对照组(正常组)35例,试验组(骨质疏松组)70例,试验组又分为2个亚组,各35例:试验1组(单纯骨质疏松组)和试验2组(骨质疏松骨折组)。采用双能X线骨密度仪检测腰椎骨密度(BMD),酶联免疫吸附法(ELISA)检测血清OPG、RANKL浓度,电化学发光免疫分析法(ECLIA)检测血清25(OH)D、P1NP和β-CTX的浓度。采用Logistic回归模型判定骨折危险因素。结果试验组患者年龄、血清RANKL、P1NP和β-CTX水平高于对照组,体重指数(BMI)、BMD和血清OPG、25(OH)D水平低于对照组,组间比较差异有统计学意义(P0.01);试验2组患者血清RANKL、β-CTX高于试验1组,血清OPG、P1NP、25(OH)D低于试验1组,组间比较差异有统计学意义(P0.05);Logistic回归分析:年龄(OR=1.169)、血清β-CTX水平(OR=35.597)是绝经后骨质疏松症的危险因素,血清高RANKL水平(OR=17.024)是绝经后骨质疏松性骨折的预警因素。结论绝经后妇女随着年龄增大、血清β-CTX水平上升,骨质疏松症的发病率升高。血清高RANKL水平是预测绝经后骨质疏松性骨折的危险因子。     

绝经后妇女骨质疏松性骨折易发因素的流行病学研究

目的 探讨绝经后妇女骨质疏松性骨折的分布特征和易发因素。方法 以社区50-69岁绝经1年以上妇女为研究对象,问卷调查危险因素,双能X线骨密度仪测量骨密度(Bone MineralDensity,BMD),胸腰椎侧位X摄片分析椎体骨折,结合病史问询调查骨折发生。结果 绝经后妇女骨质疏松性骨折的发生率随年龄和绝经年限的延长而上升,尤其是绝经后的15-20年,骨质疏松性骨折的发生率明显升高。至少有一处以上骨折的绝经后妇女较无骨折妇女的年龄大、绝经年龄早、绝经年限长、生育次数多、哺乳月份长(P<0.01)。结论 绝经早、生育胎数多、哺乳时间长等因素是绝经后妇女骨质疏松性骨折的重要危险因素,可作为骨折高危人群的筛选指标以及制定相应干预措施的依据。     

Social and emotional factors as predictors of poor outcomes following cardiac surgery

 Open in a separate windowOBJECTIVESExisting risk prediction models in cardiac surgery stratify individuals based on their predicted risk, including only medical and physiological factors. However, the complex nature of risk assessment and the lack of parameters representing non-medical aspects of patients’ lives point towards the need for a broader paradigm in cardiac surgery. Objectives were to evaluate the predictive value of emotional and social factors on 4 outcomes; death within 90 days, prolonged stay in intensive care (≥72 h), prolonged hospital admission (≥10 days) and readmission within 90 days following cardiac surgery, as a supplement to traditional risk assessment by European System for Cardiac Operative Risk Evaluation (EuroSCORE).METHODSThe study included adults undergoing cardiac surgery in Denmark 2014–2017 including information on register-based socio-economic factors, and, in a nested subsample, self-reported symptoms of anxiety and depression. Logistic regression analyses were conducted, adjusted for EuroSCORE, of variables reflecting social and emotional factors.RESULTSAmongst 7874 included patients, lower educational level (odds ratio 1.33; 95% confidence interval 1.17–1.51) and living alone (1.25; 1.14–1.38) were associated with prolonged hospital admission after adjustment for EuroSCORE. Lower educational level was also associated with prolonged intensive care unit stay (1.27; 1.00–1.63). Having a high income was associated with decreased odds of prolonged hospital admission (0.78; 0.70–0.87). No associations or predictive value for symptoms of anxiety or depression were found on any outcomes.CONCLUSIONSSocial disparity is predictive of poor outcomes following cardiac surgery. Symptoms of anxiety and depression are frequent especially amongst patients with a high-risk profile according to EuroSCORE.Subj collection105, 123     

西部二级城市女性乳腺癌发病风险相关因素分析及风险预测模型的建立

目的探讨西部二级城市女性乳腺癌发病风险的相关因素并建立风险预测模型，以筛查高危人群，为乳腺癌的一、二级预防提供依据。方法对随机（随机数字表法）抽取的1700例（其中门诊就诊者1020例，体检者680例）女性进行问卷调查，其中62例经病理学检查证实为乳腺癌。以X线影像及问卷调查为基础，根据x线片上的乳腺密度分为高和低密度组，就乳腺密度、年龄、体质量指数、乳腺癌家族史、社会经济地位、生活方式和生殖生育情况与乳腺癌的关系进行单因素及多因素分析，并拟合相关危险因素建立乳腺癌风险预测模型。结果单因素分析结果显示，乳腺癌的相关危险因素有年龄（P=0.006）、体质量指数（P=0.007）、初潮年龄（P=0.039）、职业（P=0.001）、长期居住地（P=0.000）、文化程度（P=0.001）、相比前1年的健康状况（P=0.046）、初产年龄（P=0.014）、是否绝经（P=0.003）及绝经年龄（P=0.006）；多因素分析（logistic回归分析）结果显示，乳腺癌的相关危险因素有年龄（P=0.003）、初产年龄（P=0.000）、职业（P=0.010）及长期居住地（P=0.000），其保护因素是初潮年龄（P=0.000）。根据多因素分析结果初步建立的所调查地区的乳腺癌风险预测模型为y=-5.557＋0.042x1-0.375x2＋1.206x3＋0.509x4＋2.135x5，拟合系数（R square）=0.170，能反应出实际情况的17％。结论通过流行病学调查并结合相关风险因素分析建立的乳腺癌风险预测模型，能对今后的临床工作起到一定的指导作用，但该模型尚需进行大规模人群的验证研究。     

Assessment of left ventricular ejection fraction may invalidate the reliability of EuroSCORE

Objective: To evaluate the impact of different echocardiographic methods for assessment of left ventricular dysfunction on the predictive value of EuroSCORE and thus its reliability in daily practice and benchmarking. Methods: Twenty-five recordings obtained by transthoracic echocardiography, optimal for study using four different echocardiographic methods, were examined and placed into relevant EuroSCORE classes. The four methods were eyeballing, Wall Motion Index, Simpson 2D volumetric method and Motion mode. Results: Bland and Altman plots showed that the three specific methods were not fully interchangeable. Using eyeballing as the key reference, only 44% of patients were placed in the same EuroSCORE class with all four methods. The quantitative echocardiographic methods in general overestimate the ejection fraction compared to eyeballing. Conclusion: The left ventricular dysfunction factor in the EuroSCORE risk assessment system needs a more precise definition.     

Does receiving high or low breast cancer risk estimates produce a reduction in subsequent breast cancer screening attendance? Cohort study

Risk-stratified breast cancer screening may improve the balance of screening benefits to harms.We assess a potential new harm: reduced screening attendance in women receiving below average-risk (false reassurance) or higher-risk results (screening avoidance). Following initial screening, 26,668 women in the PROCAS study received breast cancer risk estimates, with attendance recorded for two subsequent screening rounds. First-screen attendance was slightly reduced in below-average (85.6%) but not higher-risk women, compared to other women (86.4%). Second-screen attendance increased for women at higher-risk (89.2%) but not below-average, compared to other women (78.8%). Concerns about this potential harm of risk-stratified screening therefore appear unfounded.     

Hussman病情和体质状况评估方法预测围术期并发症

目的探讨Hussman病情和体质状况评估方法预测围术期并发症的作用。方法2015年5月至2016年5月各科手术患者2 494例,男1 462例,女1 032例,采用Hussman病情和体质状况评估方法进行风险评估,观察并记录围术期并发症的发生情况。结果 2 494例患者围术期发生并发症336例(13.47%),其中心血管并发症是主要并发症,占80.7%。风险等级1、2、3、4、5级患者分别有1 540例(61.75%)、660例(26.46%)、202例(8.10%)、80例(3.21%)和12例(0.48%),发生并发症分别有112例(7.28%)、82例(12.42%)、82例(40.59%)、50例(62.50%)和10例(83.33%),敏感度分别为33.33%、24.40%、24.40%、14.88%和2.78%,特异度分别为33.76%、73.26%、94.44%、98.61%和99.91%,准确度分别为33.76%、66.64%、85.01%、87.33%和86.85%。结论 Hussman病情和体质状况评估方法能较好地预测围术期并发症。     

慢性HBV病毒感染与骨质疏松症之间的关系研究

目的研究乙型肝炎病毒(hepatitis B virus,HBV)感染与骨质疏松症之间的相关性。方法对2008年1月至2016年1月我院收治的10000例患者的临床资料作回顾性分析,其中2145例HBV感染者和2145例非HBV感染者分别归为研究组和对照组。分析研究HBV感染与骨质疏松症之间的相关性。结果研究组和对照组的年龄、性别、合并症以及药物使用分布等一般资料之间的差异没有统计学意义(P0.05)。感染HBV病毒和未感染HBV病毒的患者骨质疏松症的发病率分别为0.28%和0.26%,调整年龄、性别、合并症、药物治疗等因素后骨质疏松症的风险比(95%CI)为1.15(1.02~1.27)。HBV感染引起的骨质疏松风险随年龄而下降,对于年龄≤49岁的患者,HBV感染患者的骨质疏松症风险显著高于无HBV感染者,风险比为1.43(1.17~1.72)。HBV感染引起的骨质疏松症风险随着合并症的发生而降低,有合并症的风险比为1.02(0.90~1.17),无合并症的风险比为1.26(1.08~1.49)。结论 HBV增加骨质疏松的风险,但HBV感染的影响较小,HBV对骨质疏松性骨折无影响。     

Living with a `women's disease': risk appraisal and management among men with osteoporosis

Background

There is clear evidence that men suffer from osteoporosis (OP) in increasing numbers, but that men commonly remain underdiagnosed, undertreated and experience poorer outcomes than do women. The widespread sociocultural association of OP with postmenopausal women reflects their greater risk for developing the disorder, but the sexing of OP as a women's disease disadvantages at-risk men.

Methods

This paper reports on qualitative data gathered from 23 community-residing men who have an OP diagnosis.

Results

Interviews with men reveal that the sexing of OP as a female disease may affect men's risk appraisal. Men clearly associate OP risk factors with women and accordingly may feel protected from the disorder. Subsequent to diagnosis, men's OP-related risk management strategies reveal that men's gender identity constrains their ability to enact risk-reducing behavior.

Conclusions

Men may internalize the association of OP with women and incorporate it into a sense of perceived invulnerability to the condition, which, in turn, contributes to delayed diagnosis and treatment. Limited male-specific treatment and support options as well as social expectations of male gender performance play roles in men's health behavior.     

Risk Estimates for Hip Fracture From Clinical and Densitometric Variables and Impact of Database Selection in Lebanese Subjects

Bone mineral density (BMD) and fracture incidence vary greatly worldwide. The data, if any, on clinical and densitometric characteristics of patients with hip fractures from the Middle East are scarce. The objective of the study was to define risk estimates from clinical and densitometric variables and the impact of database selection on such estimates. Clinical and densitometric information were obtained in 60 hip fracture patients and 90 controls. Hip fracture subjects were 74 yr (9.4) old, were significantly taller, lighter, and more likely to be taking anxiolytics and sleeping pills than controls. National Health and Nutrition Examination Survey (NHANES) database selection resulted in a higher sensitivity and almost equal specificity in identifying patients with a hip fracture compared with the Lebanese database. The odds ratio (OR) and its confidence interval (CI) for hip fracture per standard deviation (SD) decrease in total hip BMD was 2.1 (1.45–3.05) with the NHANES database, and 2.11 (1.36–2.37) when adjusted for age and body mass index (BMI). Risk estimates were higher in male compared with female subjects. In Lebanese subjects, BMD- and BMI-derived hip fracture risk estimates are comparable to western standards. The study validates the universal use of the NHANES database, and the applicability of BMD- and BMI-derived risk fracture estimates in the World Health Organization (WHO) global fracture risk model, to the Lebanese.     

Bladder cancer risk: Use of the PLCO and NLST to identify a suitable screening cohort

PurposeBladder cancer (BC) screening is not accepted in part owing to low overall incidence. We used the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) and National Lung Cancer Screening Trial (NLST) to identify optimal high-risk populations most likely to benefit from screening.Materials and methodsData were extracted from PLCO and NLST to stratify risk of BC by overall population, sex, race, age at inclusion, and smoking status. Incidence rates between groups were compared using chi-square test.ResultsBC was identified in 1,430/154,898 patients in PLCO and 439/53,173 patients in NLST. BCs were grade III/IV in 36.8% and 41.3%. Incidence rates were significantly higher in men than in women (PLCO: 1.4 vs. 0.31/1,000 person-years and NLST: 1.84 vs. 0.6/1,000 person-years, both P<0.0001). In proportional hazards models, male sex, higher age, and duration and intensity of smoking were associated with higher risk of BC (all P<0.0001). In men older than 70 years with smoking exposure of 30 pack-years (PY) and more, incidence rates were as high as 11.92 (PLCO) and 5.23 (NLST) (per 1,000 person-years). In current high-intensity smokers (≥50 PY), the sex disparity in incidence persists in both trials (0.78 vs. 2.99 per 1,000 person-years in PLCO and 1.12 vs. 2.65 per 1,000 person-years in NLST).ConclusionsMen older than 60 years with a smoking history of>30 PY had incidence rates of more than 2/1,000 person-years, which could serve as an excellent population for screening trials. Sex differences in the incidence of BC cannot be readily explained by the differences in exposure to tobacco, as sex disparity persisted regardless of smoking intensity.