女性年龄相关的腰椎骨量与骨骼大小的关系及对诊断骨质疏松的影响  

Relationship between age-related bone mass of the lumbar spine and skeletal size and their effects on the diagnosis of osteoporosis in women

作　　者：钟如意[1] 伍贤平[1] 廖二元[1] 张红[1] 罗湘杭[1] 彭依群[1] 张蓉[1] 

机构地区：[1]湖南省浏阳市人民医院内分泌科,浏阳410300

出　　处：《中国骨质疏松杂志》2012年第2期99-105,共7页Chinese Journal of Osteoporosis

摘　　要：目的探讨腰椎骨量(面积骨密度和体积骨密度)与年龄和骨骼骨面积(BA)大小之间的关系,及腰椎骨骼大小对评价骨量和诊断骨质疏松(OP)的影响。方法采用QDR-4500A型扇形束双能X线吸收法骨密度仪,测量5585例年龄5～96岁的女性正位腰椎BA、骨矿含量(BMC)、面积骨密度(aBMD)及估算体积骨密度(vBMD)。结果腰椎aBMD和vBMD的峰值BMD(x珋±s)分别为0.9884±0.1064g/cm2和0.1310±0.0128g/cm3。在所有年龄阶段aBMD随年龄的变化率显著大于vBMD。腰椎BA与BMC、aBMD和vBMD均呈显著正相关,其中BA与BMC的相关系数最大(r=0.706,P=0.000),与aBMD的相关系数次之(r=0.394,P=0.000),与vBMD的相关系数最小(r=0.141,P=0.000)。年龄≥40岁(平均52.7±9.58岁)的受试者(n=4012)腰椎BA按四分位数分成Q1、Q2、Q3和Q4组,4个组之间的BA、BMC和aBMD的平均值均有显著性差异。采用aBMD诊断OP,4个组的OP检出率分别为Q1=33.6%、Q2=17.9%、Q3=13.3%和Q4=8.39%,呈显著性梯次降低;与总体组比较,Q1组的患病风险增加126%,Q2、Q3和Q4组的患病风险分别降低3%、31%和59%。采用vBMD诊断OP,4个组的OP检出率分别为Q1=27.4%、Q2=18.3%、Q3=15.9%和Q4=14.0%,其梯次差异显著低于aBMD;与总体组比较,Q1组的患病风险增加62%,Q2、Q3和Q4组的患病风险分别降低4%、19%和30%。Q1组aBMD的OP检出率显著高于vBMD,Q4组aBMD的OP检出率显著低于vBMD。在椎体最小的Q1组,aBMD(OR=2.26)的患病风险比vBMD(OR=1.62)大约高64%,在椎体最大的Q4组,aBMD(OR=0.41)的患病风险比vBMD(OR=0.70)大约低29%。结论该研究揭示腰椎vBMD并不能完全消除骨骼大小对评价骨量和诊断OP的影响。在腰椎椎体较小的受试者,aBMD诊断OP的敏感性高于vBMD;在椎体较大的受试者,vBMD诊断OP的敏感性则高于aBMD。Objective To explore the relationships between bone mass of lumbar,including the areal bone mineral density and volumetric bone mineral density,and age and bone area（BA）,and to explore the effects of lumbar skeletal size on the evaluation of bone mass and diagnosis of osteoporosis（OP）.Methods BA,bone mineral content（BMC）,areal bone mineral density（aBMD）,and estimated volumetric bone mineral density（vBMD） at the lumbar spine of 5585 females,aged from 5 to 96 years old,were measured using QDR-4500A fan beam dual-energy X-ray absorptiometry bone densitometer.Results Peak BMD（±s） of aBMD and vBMD at the lumbar spine were 0.9884±0.1064g/cm2 and 0.1310±0.0128g/cm3,respectively.The change of aBMD varied with age was significantly higher than that of vBMD at all age grades.There were significant positive correlations between BA and BMC,aBMD,and vBMD.The coefficient of correlation between BA and BMC was the highest（r=0.706,P=0.000）.The coefficient of correlation between BA and aBMD was lower than the coefficient of correlation between BA and BMC（r=0.394,P=0.000）.The coefficient of correlation between BA and vBMD was the lowest（r=0.141,P=0.000）.The subjects over 40 years old（the average age 52.7±9.58 years old,n=4012） were divided into 4 groups,Q1,Q2,Q3 and Q4,according to BA quartile at the lumbar spine.The mean values of BA,BMC and aBMD among 4 groups were significantly different.If aBMD were used to diagnose OP,the detection rates of OP among the 4 groups were 33.6% in Q1,17.9% in Q2,13.3% in Q3,and 8.39% in Q4,respectively,and the rates decreased gradually and significantly.The risks of OP in Q1 increased 126% compared with the rate of whole population,while that in Q2,Q3,and Q4 decreased by 3%,31%,59%,respectively.When vBMD were used to diagnose OP,the detection rates of OP among these 4 groups were 27.4% in Q1,18.3% in Q2,15.9% in Q3,and 14.0% in Q4,respectively.The gradient difference was significantly lower than aBMD.The risks of OP in Q1 group increased 62% compared with

关 键 词：腰椎 骨面积 面积骨密度 体积骨密度 骨质疏松 

分 类 号：R816.8[医药卫生—放射医学]