Department of Radiology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province 210017, China.
Department of Healthcare Administration and Department of Dental Technology and Materials Science, Central Taiwan University of Science and Technology, Taichung 40601, Taiwan.
J Healthc Eng. 2018 Mar 22;2018:9621640. doi: 10.1155/2018/9621640. eCollection 2018.
More than 1 billion people suffer from chronic respiratory diseases worldwide, accounting for more than 4 million deaths annually. Inhaled corticosteroid is a popular medication for treating chronic respiratory diseases. Its side effects include decreased bone mineral density and osteoporosis. The aims of this study are to investigate the association of inhaled corticosteroids and fracture and to design a clinical support system for fracture prediction. The data of patients aged 20 years and older, who had visited healthcare centers and been prescribed with inhaled corticosteroids within 2002-2010, were retrieved from the National Health Insurance Research Database (NHIRD). After excluding patients diagnosed with hip fracture or vertebrate fractures before using inhaled corticosteroid, a total of 11645 patients receiving inhaled corticosteroid therapy were included for this study. Among them, 1134 (9.7%) were diagnosed with hip fracture or vertebrate fracture. The statistical results showed that demographic information, chronic respiratory diseases and comorbidities, and corticosteroid-related variables (cumulative dose, mean exposed daily dose, follow-up duration, and exposed duration) were significantly different between fracture and nonfracture patients. The clinical decision support systems (CDSSs) were designed with integrated genetic algorithm (GA) and support vector machine (SVM) by training and validating the models with balanced training sets obtained by random and cluster-based undersampling methods and testing with the imbalanced NHIRD dataset. Two different objective functions were adopted for obtaining optimal models with best predictive performance. The predictive performance of the CDSSs exhibits a sensitivity of 69.84-77.00% and an AUC of 0.7495-0.7590. It was concluded that long-term use of inhaled corticosteroids may induce osteoporosis and exhibit higher incidence of hip or vertebrate fractures. The accumulated dose of ICS and OCS therapies should be continuously monitored, especially for patients with older age and women after menopause, to prevent from exceeding the maximum dosage.
全世界有超过 10 亿人患有慢性呼吸系统疾病，每年导致超过 400 万人死亡。吸入性皮质类固醇是治疗慢性呼吸系统疾病的常用药物。其副作用包括骨密度降低和骨质疏松症。本研究旨在探讨吸入性皮质类固醇与骨折的关系，并设计骨折预测的临床支持系统。从国家健康保险研究数据库（NHIRD）中检索了 2002-2010 年间在医疗保健中心就诊并接受吸入性皮质类固醇治疗的 20 岁及以上患者的数据。在排除使用吸入性皮质类固醇之前诊断为髋部骨折或脊椎骨折的患者后，共有 11645 名接受吸入性皮质类固醇治疗的患者纳入本研究。其中，1134 名（9.7%）患者诊断为髋部骨折或脊椎骨折。统计结果显示，骨折患者和非骨折患者在人口统计学信息、慢性呼吸系统疾病和合并症以及皮质类固醇相关变量（累积剂量、平均暴露日剂量、随访时间和暴露时间）方面存在显著差异。通过随机和基于聚类的欠采样方法获得平衡训练集来训练和验证模型，并使用不平衡的 NHIRD 数据集进行测试，设计了集成遗传算法（GA）和支持向量机（SVM）的临床决策支持系统（CDSS）。采用了两种不同的目标函数来获得具有最佳预测性能的最优模型。CDSS 的预测性能表现出 69.84-77.00%的灵敏度和 0.7495-0.7590 的 AUC。结论是，长期使用吸入性皮质类固醇可能会导致骨质疏松症，并表现出更高的髋部或脊椎骨折发生率。应持续监测 ICS 和 OCS 治疗的累积剂量，特别是对于年龄较大和绝经后女性的患者，以防止超过最大剂量。
