中老年男性骨质疏松(OP)危险分层与定量超声骨密度(QUS-BMD)及双能X线骨密度(DXA-BMD)的相关性  

Association of osteoporosis(OP)risk stratification and QUS-BMD and DXA-BMD among middle-aged old males

作　　者：查小云[1] 庞晓娜[1] 李锂[1] 常桂林[1] 胡予[1] 

机构地区：[1]复旦大学附属中山医院老年科,上海200032

出　　处：《复旦学报（医学版）》2014年第4期504-510,共7页Fudan University Journal of Medical Sciences

摘　　要：目的分析亚洲人骨质疏松(osteporsis,OP)自我筛查工具(osteoporosis self-assessment tool for Asian,OSTA)指数与骨密度(bone mineral density,BMD)的相关性,并探讨跟骨定量超声(quantitative ultrasound,QUS)测定BMD对中老年男性OP的诊断价值。方法对893例45岁以上男性研究对象行QUS-BMD检查,记录跟骨QUS-BMD及QUS-T值,测量身高、体重,计算OSTA指数,其中255例研究对象同时行双能X线(dual-energy Xray absorptionmetry,DXA)BMD测定,按OSTA分层标准将受试者分为OP高、中、低风险组。比较各组间跟骨QUS-BMD、QUS-T以及各部位DXA-BMD的差异,分析OSTA指数与髋部、腰椎DXA-BMD的相关性。根据WHO的OP诊断金标准(骨质疏松:T值≤-2.5,骨量减少:-2.5<T值<-1,骨量正常:T值≥-1)将受试者分为OP组、骨量减少组和骨量正常组,评价跟骨QUS-T值对OP的诊断价值。结果 DXA-BMD测定者中,OP者71例(27.8%),骨量减少者143例(56.1%),骨量正常者41例(16.1%)。OSTA分层高、中、低不同OP风险组中,股骨颈、全髋和全腰椎BMD逐渐升高,高危组明显低于中危组和低危组(P<0.05),而中、低危组间的差异无统计学意义(P>0.05)。OP风险高、中、低危3组中OP患病例数分别为37例(48.7%)、17例(17.5%)和17例(20.7%),高危组中OP患病例数显著高于中、低危组(P<0.05)。Spearman相关分析示OSTA指数与股骨颈、全髋及全腰椎BMD呈显著正相关(P<0.05),相应的相关系数分别为0.448、0.439和0.141。跟骨QUS-BMD和QUS-T值在不同OP风险组间的差异无统计学意义(P>0.05)。跟骨QUS-T值诊断OP的曲线下面积为0.753,最佳截断值为-1.3,相应的灵敏度和特异度分别为77.5%和61.4%。结论随着OSTA指数升高,OP风险降低,股骨颈、全髋及全腰椎的BMD升高,OSTA指数与各部位DXA-BMD成线性正相关。OSTA指数和跟骨QUST值对诊断中老年男性OP症筛查具有一定的价值。Objective To analyse the correlation between osteoporosis （OP） self-assessment tool for Asian （OSTA） index and bone mineral density （BMD）,and to explore the value of calcaneal BMD detected by quantitative ultrasound （QUS） for diagnosing OP in elderly men.Methods We underwent ultrasound bone density examination in 893 subjects aged above 45,recorded QUS-BMD and QUS-T,completed height and weight measurements and calculated OSTA index,among which 255 cases got dual-energy X-ray absorptiometry （DXA） bone mineral density （BMD） examination.Then we devided all subjects into high,medium and low-risk groups according to the OSTA classify standard and compared the differences of QUS-BMD,QUS-T,and DXA-BMD between these groups and analyzed the correlation between OSTA index and DXA-BMD.We classified those who completed DXA test into 3 groups （OP,osteopenia and normal bone mass） according to the WHO OP diagnostic criteria and analyzed the value of QUS-T in identifying OP and low bone mass in elderly men.Results The average age of the study population was （73.0 ± 10.4） years.There were 71 cases of OP （27.80%）,143 cases of osteopenia （56.1%） and 41 cases of normal bone mass （16.1%） among those who got DXA examination.BMD at femoral neck,total hip and total lumbar increased in groups of high,medium and low-risk for OP and had statistically significance between high-risk group and medium-risk group or low-risk group （P〈0.05）,while there was no significant difference between medium-risk group and low-risk group （P〉0.05）.The number of OP was 37 cases （48.7%）,17 cases （17.5%） and 17 cases （20.7 %） in high,medium and low-risk group,respectively,and the OP prevalence in high-risk group was higher than those in medium-risk group and low-risk group （P 〈 0.05）.Spearman correlation analysis showed that OSTA index was positively correlated with femoral neck,total hip and total spine BMD significantly （P〈0.05）,and the corresponding correlation coefficients were

关 键 词：骨质疏松(OP) 亚洲人骨质疏松自我筛查工具(OSTA) 骨密度(BMD) 

分 类 号：R681[医药卫生—骨科学]