腰椎QCT与DXA对老年骨质疏松的诊断差异  

Diagnostic discordance of osteoporosis using spinal QCT and DXA in Chinese elderly

作　　者：李凯[1] 李新民[1] 闫东[1] 程克斌[1] 翁磊[1] 李瑾[1] 张萍[2] 李晓玉[2] 顾翔[1] 程晓光[1] 

机构地区：[1]北京积水潭医院放射科,北京100035 [2]北京积水潭医院干部科,北京100035

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2017年第3期271-276,共6页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：国家自然科学基金(81071131);北京市卫生系统高层次卫生技术人才培养项目(2009-2-03);首都卫生发展科研专项自主创新项目(2014-2-1122)

摘　　要：目的研究腰椎定量CT(quantitative computed tomography,QCT)和双能X线吸收检测仪(dual-energy X-ray absorptiometry,DXA)检测骨密度(bone mineral density,BMD)诊断老年人群骨质疏松效能的差异。方法收集北京积水潭医院同时接受腰椎DXA、髋部DXA和腰椎QCT检查、年龄>60岁的老年患者614例。DXA诊断骨质疏松采用世界卫生组织(World Health Organization,WHO)推荐的标准:T值≤-2.5 SD为骨质疏松,-2.5 SD<T<-1.0 SD为低骨量,≥-1.0 SD为正常。QCT采用美国放射学院(American College of Radiology,ACR)的诊断标准,腰椎BMD<80 mg/cm^3为骨质疏松,>120 mg/cm3为正常,80 mg/cm^3≤BMD≤120 mg/cm^3为低骨量。当两种方法诊断骨质疏松只有一个分类差别时,称为小差异;当一种方法诊断为骨质疏松而另一种方法诊断为骨量正常时,这种差异称为大差异。比较DXA和QCT诊断骨质疏松的结果差异。结果在614例平均年龄(76.3±26.0)岁的老年人群中,DXA和QCT诊断骨质疏松的大差异、小差异和诊断一致率分别为5.9%、46.9%和47.2%。DXA(腰椎正位、髋部)和腰椎QCT对骨质疏松的检出率差异有统计学意义(χ~2=177.96,P<0.01)。结论利用腰椎QCT测量BMD对老年人群骨质疏松的诊断具有重要价值。Objective To investigate the diagnostic discordance for osteoporosis using spine quantitative computed tomography （QCT） and dual-energy X-ray absorptiometry （DXA） in the elderly Chinese population. Methods Totally 614 subjects older than 60 years underwent both QCT scanning and spine, hip DXA. The diagnosis of osteoporosis by DXA was followed the standard of World Health Organization （WHO） ： T score ≤ - 2.5 SD as osteoporosis, -2.5 - - 1.0 SD as osteopenia, ≥ - 1.0SD as normal. The diagnosis of osteoporosis by QCT was followed the criterion recommended by the American College of Radiology： bone mineral density of lumbar vertebra 〈 80 mg/cm3 as osteoporosis, 〉 120 mg/cm3 as normal, 80 mg/cm3 ≤ bone mineral density ≤ 120 mg,/cm3 as osteopenia. Minor discordance was defined as when the diagnostic difference between two methods was only one diagnostic class. Major discordance was present when one was osteoporotic and the other was normal. The diagnostic differences between DXA and QCT were compared. Results In 614 participants [ mean age （76. 3±26. 0 ） years], major discordance, minor discordance, and concordance of osteoporotic diagnosis by DXA and QCT were found in 5.9% , 46. 9% and 47. 2%, respectively. The detection rate of DXA （ spine P-A projection, hip） on osteoporosis was lower than that of QCT （X2 = 177.96, P 〈 0. 01 ）. Conclusion Bone mineral density measurements of lumbar vertebra by QCT play an important role on the diagnosis of osteoporosis in elderly Chinese population.

关 键 词：骨质疏松 骨密度 体层摄影术 X线计算机 

分 类 号：R681[医药卫生—骨科学]