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[1]孫繼高,唐開強,鄭澤陸,等.骨質疏松高風險人群中醫(yī)辨識量表的測試優(yōu)化研究[J].中醫(yī)正骨,2023,35(09):37-43.
　SUN Jigao,TANG Kaiqiang,ZHENG Zelu,et al.A study of testing and optimization of the traditional Chinese medicine identification scale for high-risk population of osteoporosis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(09):37-43.
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骨質疏松高風險人群中醫(yī)辨識量表的測試優(yōu)化研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期數:
2023年09期
頁碼:
37-43
欄目:
調查研究
出版日期:
2023-09-20

文章信息/Info

Title:
A study of testing and optimization of the traditional Chinese medicine identification scale for high-risk population of osteoporosis
作者:
孫繼高1; 唐開強2; 鄭澤陸2; 王榮田2; 何海軍3; 奚向宇4; 陳衛(wèi)衡2
1.北京中醫(yī)藥大學東方醫(yī)院,北京 100078; 2.北京中醫(yī)藥大學第三附屬醫(yī)院,北京 100029; 3.中國中醫(yī)科學院望京醫(yī)院,北京 100102; 4.北京市西城區(qū)廣外醫(yī)院,北京 100055
Author(s):
SUN Jigao1; TANG Kaiqiang2; ZHENG Zelu2; WANG Rongtian2; HE Haijun3; XI Xiangyu4; CHEN Weiheng2
1.Dongfang Hospital,Beijing University of Chinese Medicine,Beijing 100078,China2.Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029,China3.Wangjing Hospital of CACMS,Beijing 100102,China4.Beijing Xicheng Guangwai Hospital,Beijing 100055,China
關鍵詞:
骨質疏松;  辨識;  量表;  風險評估;  可行性;  信度;  效度
Keywords:
osteoporosis;  identification;  scale;  risk assessment;  feasibility;  reliability;  validity
摘要:
目的:對骨質疏松高風險人群中醫(yī)辨識量表進行測試優(yōu)化。方法:以2020年9月至2021年1月在北京中醫(yī)藥大學第三附屬醫(yī)院、中國中醫(yī)科學院望京醫(yī)院及北京市西城區(qū)廣外醫(yī)院門診就診的患者為調查對象,要求調查對象完成骨質疏松高風險人群中醫(yī)辨識量表、國際骨質疏松基金會(International Osteoporosis Foundation,IOF)骨質疏松風險一分鐘測試題、亞洲人骨質疏松癥自我篩查工具(osteoporosis self-assessment tool for Asians,OSTA)量表、疼痛視覺模擬量表(visual analogue scale,VAS)、簡明健康狀況調查表(short form 36 health survey questionnaire,SF-36)及骨密度檢測(包括腰椎和髖部)。評價骨質疏松高風險人群中醫(yī)辨識量表的可行性、信度、效度及判別效果。結果:①可行性評價結果。共發(fā)放骨質疏松高風險人群中醫(yī)辨識量表250份,回收236份,有效量表228份,回收率94.4%,有效率91.2%。調查對象完成骨質疏松高風險人群中醫(yī)辨識量表的時間均≤5 min。所有調查對象均同時完成骨密度檢測及其余4個量表,調查對象完成所有量表的時間均≤20 min。②信度評價結果。骨質疏松高風險人群中醫(yī)辨識量表的克龍巴赫α系數為0.882、Spearman-Brown系數為0.891,其中針對前10個條目的克龍巴赫α系數為0.770。③結構效度評價結果。經探索性因子分析,骨質疏松高風險人群中醫(yī)辨識量表的32個條目中,手足煩熱和健忘2個條目的負荷值在所有因子上均<0.4,予以剔除。對剩余30個條目重新進行探索性因子分析,共提取出9個公因子,累積方差貢獻率為61.215%。9個公因子分別代表下肢癥狀、頭目癥狀、疼痛癥狀、睡眠情緒、頭面體征、寒熱癥狀、軀體體征、軀體癥狀、頭面癥狀9個維度,對應的中醫(yī)證候體現了骨質疏松癥患者腎精虧虛、腎陽虛、肝腎陰虛、肝郁血虛、脾胃虛弱等病機特點,也與原發(fā)性骨質疏松癥中醫(yī)證型基本相符。對量表中前10個條目進行探索性因子分析,共提取出3個公因子,累積方差貢獻率為61.200%。3個公因子分別代表軀體癥狀、疼痛及軀體體征3個維度。應用SPSS AMOS24軟件對上述3因子分析模型進行驗證性因子分析,結果顯示模型擬合較好。④效標關聯效度評價結果。骨質疏松高風險人群中醫(yī)辨識量表前10個條目評分和量表總分(30個條目)與骨密度分類、腰椎骨密度、髖部骨密度及SF-36中8個方面得分均呈負相關(骨密度分類:r=-0.190,P=0.004; r=-0.231,P=0.000; 腰椎骨密度:r=-0.144,P=0.030; r=-0.198,P=0.003; 髖部骨密度:r=-0.218,P=0.001; r=-0.272,P=0.000; SF-36生理功能:r=-0.280,P=0.000; r=-0.330,P=0.000; SF-36生理職能:r=-0.324,P=0.000; r=-0.346,P=0.000; SF-36身體疼痛:r=-0.430,P=0.000; r=-0.434,P=0.000; SF-36總體健康:r=-0.460,P=0.000; r=-0.495,P=0.000; SF-36活力:r=-0.220,P=0.001; r=-0.292,P=0.000; SF-36社會功能:r=-0.282,P=0.000; r=-0.326,P=0.000; SF-36情感職能:r=-0.174,P=0.009; r=-0.259,P=0.000; SF-36精神健康:r=-0.251,P=0.000; r=-0.320,P=0.000),與OSTA指數、疼痛VAS評分均呈正相關(OSTA指數:r=0.153,P=0.021; r=0.140,P=0.035; 疼痛VAS評分:r=0.453,P=0.000; r=0.430,P=0.000); IOF骨質疏松風險一分鐘測試結果與前10個條目評分不存在相關性(r=0.127,P=0.055),與量表總分(30個條目)呈正相關(r=0.168,P=0.011)。⑤判別效果。以骨密度診斷結果為金標準,基于骨質疏松高風險人群中醫(yī)辨識量表前10個條目評分和量表總分(30個條目)判別骨量異常的受試者操作特征曲線下面積分別為0.636[95%CI(0.564,0.709)]和0.650[95%CI(0.579,0.721)],最佳截斷值分別為2分和5分,即符合骨質疏松高風險人群中醫(yī)辨識量表前10個條目中的2個及以上,或符合全部30個條目中的5個及以上,就可判定為骨量異常,為骨質疏松高風險人群。結論:骨質疏松高風險人群中醫(yī)辨識量表具有較好的可行性和信度; 優(yōu)化后的量表具有良好的效度,具備一定的判別骨量異常的能力,可用于骨質疏松高風險人群的篩查評估。
Abstract:
Objective:To test and optimize the traditional Chinese medicine(TCM)identification scale for high-risk population of osteoporosis(OP).Methods:Patients who were treated in Beijing University of Chinese Medicine Third Affiliated Hospital,Wangjing Hospital of CACMS and Beijing Xicheng Guangwai Hospital from September 2020 to January 2021 were selected as the subjects.The participants were asked to complete the TCM identification scale for high-risk population of OP,the International Osteoporosis Foundation(IOF)one-minute OP risk check,the osteoporosis self-assessment tool for Asians(OSTA)scale,the pain visual analogue scale(VAS),the short form 36 health survey questionnaire(SF-36)and bone mineral density(BMD)measurement(including lumbar spine and hip).The feasibility,reliability,validity and discriminative effects of the TCM identification scale for high-risk population of OP were evaluated.Results:①Results of feasibility evaluation.Two hundred and fifty TCM identification scale questionnaires for high-risk population of OP were handed out,and 236 ones returned,among which 228 ones were valid,with the response rate of 94.4% and the effective rate of 91.2%,and the time for participants to finish the scale did not exceed 5 minutes.All participants finished the BMD measurement and the other 4 scales synchronously,and the time for them to finish all scales was less than 20 minutes.②Results of reliability evaluation.The Cronbach's α coefficient of the TCM identification scale for high-risk population of OP was 0.882,and the Spearman-Brown coefficient was 0.891,with a Cronbach's α coefficient of 0.770 for the first 10 items.③Results of structural validity evaluation.As indicated by exploratory factor analysis,among the 32 items in the TCM identification scale for high-risk population of OP,2 items,i.e.,“vexing heat in the extremities”and“forgetfulness”,had factor loadings of<0.4 across all factors and were therefore excluded.An exploratory factor analysis was re-performed on the remaining 30 items,9 common factors were extracted,with a cumulative variance contribution rate of 61.215%.The 9 common factors represented 9 dimensions,including lower limb symptoms,head and eye symptoms,pain symptoms,sleep emotions,head-face signs,cold and heat symptoms,physical signs,physical symptoms,and head-face symptoms.These dimensions corresponded to the TCM syndromes of OP patients,including kidney-essence deficiency,kidney-yang deficiency,liver-kidney yin deficiency,liver-qi stagnation and blood deficiency,and spleen-stomach weakness,which were generally consistent with the TCM syndromes of primary OP.Another exploratory factor analysis was performed on the top 10 items of the scale,3 common factors were extracted with a cumulative variance contribution rate of 61.200%.These 3 common factors represented 3 dimensions,i.e.,physical symptoms,pain signs and physical signs.The models generated from the above 3 common factors analyses were further validated through confirmatory factor analysis using SPSS AMOS24 software,and the results indicated a good model fit.④Results of criterion-related validity evaluation.The scores of the top 10 items of the TCM identification scale for high-risk population of OP and the total score(30 items)were negatively correlated with BMD classification,lumbar spine BMD,hip BMD and scores of 8 aspects in SF-36(BMD classification:r=-0.190,P=0.004; r=-0.231,P=0.000; lumbar spine BMD:r=-0.144,P=0.030; r=-0.198,P=0.003; hip BMD:r=-0.218,P=0.001; r=-0.272,P=0.000; SF-36 physical function:r=-0.280,P=0.000; r=-0.330,P=0.000; SF-36 role-physical:r=-0.324,P=0.000; r=-0.346,P=0.000; SF-36 bodily pain:r=-0.430,P=0.000; r=-0.434,P=0.000; SF-36 general health:r=-0.460,P=0.000; r=-0.495,P=0.000; SF-36 vitality:r=-0.220,P=0.001; r=-0.292,P=0.000; SF-36 social function:r=-0.282,P=0.000; r=-0.326,P=0.000; SF-36 role-emotional:r=-0.174,P=0.009; r=-0.259,P=0.000; SF-36 mental health:r=-0.251,P=0.000; r=-0.320,P=0.000).The scores of the top 10 items of the TCM identification scale for high-risk population of OP and the total score(30 items)were positively correlated with the OSTA index and pain VAS score(OSTA index:r=0.153,P=0.021; r=0.140,P=0.035; pain VAS score:r=0.453,P=0.000; r=0.430,P=0.000).The results of IOF one-minute OP risk check were not correlated with the scores of the top 10 items(r=0.127,P=0.055),but were positively correlated with the total score(30 items)of the scale(r=0.168,P=0.011).⑤Discriminative effects.With BMD diagnosis results as the gold standard,based on the scores of the top 10 items and the total score(30 items)of the TCM identification scale for high-risk population of OP,the discriminative effects of the TCM identification scale for high-risk population of OP was evaluated by using the receiver operating characteristic(ROC)curve,and the areas under the curve(AUC)of participants with abnormal bone mass were 0.636(95%CI(0.564,0.709))and 0.650(95%CI(0.579,0.721))respectively,with the optimal cutoff values of 2 points and 5 points respectively,which suggested that participants who scored 2 points or more on the top 10 items or 5 points or more on all 30 items of the TCM identification scale could be identified as abnormal bone mass and considered as individuals at high risk of OP.Conclusion:TCM identification scale for high-risk population of OP has good feasibility and reliability.The optimized scale has good validity and a certain ability to discriminate abnormal bone mass,and can be used for screening and evaluation of high-risk population of OP.

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備注/Memo

備注/Memo:
基金項目:國家重點研發(fā)計劃項目(2018YFC1704703); 中華中醫(yī)藥學會團體標準項目(20210704-BZ-CACM); 中央高校基本科研業(yè)務費專項——北京中醫(yī)藥大學新教師啟動基金項目(2022-JYB-XJSJJ069)
通訊作者:陳衛(wèi)衡 E-mail:[email protected]
更新日期/Last Update: 1900-01-01