用三次回归模型建立女性多骨骼部位骨密度参考数据库及其应用评价

Establishment and evaluation of bone mineral density reference databases for multiple skeletal regions in women by cubic regression model

目的 建立和评价诊断女性骨质疏松 (OP)的多骨骼部位骨密度 (BMD)参考数据库。方法用QDR 45 0 0A型扇形束DXA骨密度仪测量 2 70 2例 5～ 96岁女性参考人群和 14 71例女性OP患者腰椎前后位和仰卧侧位、髋部及前臂 3 8个骨骼区域的BMD ,用 8种回归模型拟合整个健康女性人群BMD随年龄的变化 ,找出最佳拟合模型的方程建立参考数据库 ,与仪器配置的“东方女性”参考数据库同时诊断14 71例女性患者 ,评价两种参考数据库对OP检出率的差异。结果 3 8个骨骼区域BMD随年龄变化 ,用三次回归模型拟合程度均优于其他回归模型 ,拟合曲线的决定系数 (R2 )为 0 .3 6～ 0 .65 (P <0 .0 0 1)。建立的长沙女性参考数据库 ,对患者腰椎及髋部的OP检出率比“东方女性”参考数据库低 18.8%～ 3 3 .7% ,而对前臂的OP检出率则高 2 0 .4%和 2 3 .8%。两种参考数据库对OP检出率之间的差异均具有显著性 (P <0 .0 0 1)。结论 仪器配置的“东方女性”参考数据库不适合长沙地区女性诊断OP。本研究建立的女性参考数据库 ,不仅为湖南地区女性 ,而且也为中国南方地区女性诊断OP提供了可靠的参考标准。

Objective To establish and evaluate the bone mineral density (BMD) reference databases of multiple skeletal regions for diagnosis of osteoporosis (OP) in women. Methods BMD at 38 skeletal regions of anteroposterior and supine lateral spine, left hip and left forearm was measured by dual-energy X-ray absorptiometry (DXA) fan beambonedensitometer(HologicQDR-4500A)in2702 healthy women from 5 to 96 years old and 1471 women with OP, and BMD of skeletal regions with age-related changes were fitted in the whole healthy women population by eight kinds of regression models. Best model equations of fitting was found and the reference databases of OP diagnosis in women were established, and compared with the reference databases of ' oriental female' from Hologic QDR-4500A device. The differences of OP detecting rates at different skeletal regions in 1471 patients of women with OP by the two reference databases of the Changsha women and the 'oriental female' were compared and evaluated. Results BMD in 38 skeletal regions changed with aging and a cubic regression model was better fitted with age-related changes as compared to the other regression models in 38 skeletal regions for BMD, and the coefficients of determination (R 2) of fitting curve were 0.36-0.65 (P<0.001). The BMD reference databases of Changsha women were established by cubic regression equation. The detecting rates of OP were increased significantly at the skeletal sites oftheanteroposteriorandlateralspine,andhip(increased 18.8%-33.7%),butthedetectingratesofOP were decreased significantly at the regions of forearm (decreased 20.4% to 23.8%) in the patients by the 'oriental female' from the manufacturer′s reference databases as compared to the reference databases of Changsha women (P<0.001). Conclusion BMD reference databases of 'oriental female' from the manufacture is not apt to diagnose OP for women in Changsha region. This study establishes the BMD reference databases of the multiple skeletal regions of women which is the reliable reference standard for diagnosing osteoporosis at multiple skeletal regions of women not only in Hunan area but also in south China as well.