青少年特发性脊柱侧凸患者骨量减少的预测模型构建与验证

黄伟; 郑龙龙; 吕仁煜

doi:10.16766/j.cnki.issn.1674-4152.004486

青少年特发性脊柱侧凸患者骨量减少的预测模型构建与验证

doi: 10.16766/j.cnki.issn.1674-4152.004486

1.
滁州市第一人民医院脊柱外科，安徽滁州 239000
2.
滁州市第一人民医院放射科

基金项目:

国家自然科学基金项目 82372497

详细信息

通讯作者:
吕仁煜，E-mail：27164084@qq.com

中图分类号: R682.3
计量
- 文章访问数: 12
- HTML全文浏览量: 3
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2025-12-16
- 网络出版日期: 2026-10-23

Construction and validation of a predictive model for reduced bone mass in adolescent idiopathic scoliosis

1.
Department of Spinal Surgery, Chuzhou First People's Hospital, Chuzhou, Anhui 239000, China

摘要

摘要: 目的探讨青少年特发性脊柱侧凸（AIS）患者骨量减少影响因素，构建并验证列线图预测模型。方法选取2022年2月—2025年10月滁州市第一人民医院收治的265例AIS患者，依据腰椎骨密度分为骨量正常组（197例）和骨量减少组（68例）。采用logistic回归筛选独立预测因子并构建列线图，通过ROC曲线、校准曲线及决策曲线分析（DCA）评估模型性能。结果女性（OR=2.663，P=0.019）、年龄增长（OR=1.613，P < 0.001）、主弯Cobb角增大（OR=1.049，P=0.019）、表皮生长因子受体（EGFR）水平升高（OR=1.026，P=0.027）、肌酸激酶（CK）水平升高（OR=1.026，P < 0.001）是骨量减少的危险因素，椎旁肌横截面积（PMA）增大（OR=0.797，P=0.007）、25-羟维生素D[（25(OH)D]水平升高（OR=0.949，P=0.038）是保护因素。模型ROC曲线下面积（AUC）为0.880（95% CI：0.835~0.925）；校准良好，Hosmer-Lemeshow检验χ²=8.510，P=0.385；DCA显示在0.1~0.6阈值范围具有临床净获益。结论基于性别、年龄、主弯Cobb角、PMA、25(OH)D、EGFR及CK构建的列线图模型具有良好的区分度、校准度与临床实用性，可为AIS患者骨量减少的早期风险量化评估与干预提供可视化工具。
- 青少年特发性脊柱侧凸 /
- 骨量减少 /
- 影响因素 /
- 预测模型 /
- 列线图
Abstract: Objective To explore the influencing factors of reduced bone mass reduction in adolescents with idiopathic spinal curvature (AIS) and to develop and validate a nomogram prediction model. Methods A total of 265 patients with AIS treated at the First People's Hospital of Chuzhou from February 2022 to October 2025 were selected. They were divided into the normal bone mass group (197 cases) and the reduced bone mass group (68 cases) based on lumbar bone density. Multivariate logistic regression analysis was used to identify independent predictors and construct a nomogram. The performance of the model was evaluated through ROC curve, calibration curve and decision curve analysis (DCA). Results Multivariate analysis showed that female (OR=2.663, P=0.019), increasing age (OR=1.613, P < 0.001), increase in the Cobb angle of the main curve (OR=1.049, P=0.019), elevated epidermal growth factor receptor (EGFR) level (OR=1.026, P=0.027), and elevated creatine kinase (CK) level (OR=1.026, P < 0.001) are risk factors for bone loss. An increase in the cross-sectional area of paravertebral muscles (PMA, OR=0.797, P=0.007) and elevated 25-hydroxyvitamin D [(25(OH)D] level (OR=0.949, P=0.038) are protective factors. The model demonstrated good discrimination, with an area under the ROC curve (AUC) of 0.880 (95% CI: 0.835-0.925). Calibration was satisfactory, as indicated by the Hosmer-Lemeshow test (χ²=8.510, P=0.385). DCA showed a favorable net clinical benefit across threshold probabilities of 0.1-0.6. Conclusion The nomogram incorporating gender, age, main curvature Cobb angle, PMA, 25(OH)D, EGFR, and CK demonstrates good discrimination, calibration, and clinical practicability. It may serve as a visual tool for early risk assessment and intervention for reduced bone mass in AIS patients.
- Adolescent idiopathic scoliosis /
- Reduced bone mass /
- Influencing factors /
- Predictive model /
- Nomogram

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图 1 AIS患者骨量减少的列线图预测模型

Figure 1. The nomogram prediction model for bone loss in AIS patients

下载: 全尺寸图片幻灯片

图 2 模型预测AIS患者骨量减少的ROC曲线

Figure 2. The ROC curve for predicting bone loss in AIS patients by the model

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图 3 预测模型的校准曲线

Figure 3. Calibration curve of the prediction model

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图 4 预测模型的DCA曲线

Figure 4. DCA curve of the prediction model

下载: 全尺寸图片幻灯片

表 1 AIS患者骨量减少的单因素分析

Table 1. Univariate analysis of bone density reduction in AIS patients

项目	骨量正常组(n=197)	骨量减少组(n=68)	统计量	P值
性别[例(%)]			6.895^a	0.009
男性	100(50.76)	22(32.35)
女性	97(49.24)	46(67.65)
年龄(x±s，岁)	13.58±2.23	15.82±2.16	7.199^b	＜0.001
女性月经初潮年龄(x±s，岁)	12.35±1.21	12.67±1.34	1.427^b	0.156
BMI(x±s)	19.48±2.67	18.52±2.43	2.614^b	0.010
病程(x±s，月)	17.65±4.36	18.93±5.14	1.991^b	0.048
运动习惯[例(%)]			2.455^a	0.117
规律运动	82(41.62)	21(30.88)
不规律运动	115(58.38)	47(69.12)
饮食习惯[例(%)]			2.148^a	0.143
均衡	151(76.65)	46(67.65)
不均衡	46(23.35)	22(32.35)
主弯Cobb角(x±s，°)	27.83±9.76	32.02±11.85	2.883^b	0.004
顶椎位置[例(%)]			0.451^a	0.798
胸段	115(58.38)	39(57.35)
胸腰段	59(29.95)	19(27.94)
腰段	23(11.68)	10(14.71)
Risser征[例(%)]			4.664^a	0.031
0~2级	86(43.65)	40(58.82)
3~5级	111(56.35)	28(41.18)
PMA(x±s，cm²)	9.28±2.45	8.46±2.38	2.397^b	0.017
椎旁肌肌力分级[例(%)]			5.032^a	0.025
0~2级	50(25.38)	27(39.71)
3~5级	147(74.62)	41(60.29)
Ca(x±s，mmol/L)	2.39±0.14	2.37±0.16	0.978^b	0.329
P(x±s，mmol/L)	1.53±0.26	1.51±0.29	0.531^b	0.596
ALP(x±s，U/L)	179.45±68.32	191.28±75.44	1.198^b	0.232
PTH(x±s，pg/mL)	36.89±14.52	40.75±17.83	1.779^b	0.077
25(OH)D(x±s，ng/mL)	25.34±7.89	22.93±6.75	2.250^b	0.025
OCN(x±s，ng/mL)	43.87±15.64	49.02±19.05	2.209^b	0.028
P1NP(x±s，ng/mL)	446.85±97.62	469.73±104.35	1.637^b	0.103
β-CTX(x±s，ng/mL)	0.53±0.19	0.60±0.25	2.405^b	0.017
EGFR(x±s，ng/mL)	62.25±19.75	71.83±23.48	3.280^b	0.001
Mb(x±s，ng/mL)	42.35±18.52	45.78±20.05	1.289^b	0.199
CK(x±s，U/L)	114.65±32.48	145.32±36.75	6.486^b	＜0.001
注：^a为χ²值，^b为t值。

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表 2 AIS患者骨量减少的多因素logistic回归分析

Table 2. Multivariate logistic regression analysis of bone density reduction in AIS patients

变量	B	SE	Waldχ²	P值	OR值	95%CI
性别	0.980	0.419	5.478	0.019	2.663	1.173~6.049
年龄	0.478	0.093	24.345	＜0.001	1.613	1.334~1.951
主弯Cobb角	0.048	0.020	5.495	0.019	1.049	1.008~1.092
PMA	-0.227	0.084	7.265	0.007	0.797	0.675~0.940
25(OH)D	-0.052	0.025	4.286	0.038	0.949	0.903~0.997
EGFR	0.025	0.011	4.861	0.027	1.026	1.003~1.049
CK	0.026	0.006	16.537	＜0.001	1.026	1.014~1.039
常量	-12.159	2.736	19.747	＜0.001	＜0.001
注：骨量正常=0，骨量减少=1；男=0，女=1；年龄、主弯Cobb角、PMA、25(OH)D、EGFR、CK为连续变量。本表仅列出差异有统计学意义的变量。

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