定量超声骨强度仪检测桡骨骨强度在骨质疏松症诊断中的应用研究

Quantitative ultrasound bone strength meter detection radius bone strength in the diagnosis of osteoporosis

目的:在医院人群中进行跟骨和桡骨定量超声法(quantitative uitrasound test,QUS)测量骨强度(stiffness index,SI)与双能X线吸收法(dual energy X-ray absorptiometry,DXA)测量腰椎和髋部骨密度(bone mineral density,BMD)的临床对比,探讨桡骨能否替代跟骨作为超声骨强度诊断骨质疏松(osteoporosis,OP)的检测部位。方法:收集自2014年10月到2015年12月期间就诊于石河子大学第一附属医院的成年女性389例,采用DXA测定腰椎1-4、双侧股骨颈BMD值,同时采用QUS测定跟骨及桡骨SI值,以DXA为金标准,评价QUS测定跟骨和桡骨SI与BMD在骨质疏松筛查和诊断中的相关性。根据跟骨及桡骨测定的QUS-T和QUS-SI,绘制ROC曲线并计算曲线下面积,计算跟骨及桡骨诊断骨质疏松的临界值及灵敏度、特异度,探讨跟骨及桡骨QUS在诊断OP中的应用价值。结果:(1)在骨量正常组中,跟骨与桡骨的QUS与DXA检出率相差较大;在骨量减少组与骨质疏松组中,DXA分别与跟骨QUS、桡骨QUS一致性较高。(2)跟骨QUS的SI与DXA各部位BMD存在正相关关系(P<0.01),桡骨QUS的SI与DXA各部位BMD无明显相关关系。(3)跟骨QUS及桡骨QUS对骨质疏松的诊断价值:当跟骨QUS-T值诊断骨质疏松的曲线下面积为0.837,最佳截断值为-1.75,相应的灵敏度和特异度分别为80.3%和75.4%。当跟骨QUS-SI诊断骨质疏松的曲线下面积为0.847,最佳截断值为74.50,相应的灵敏度和特异度分别为80.3%和76%。桡骨QUS-T值、SI值对骨质疏松尚无诊断价值。结论:跟骨QUS测定SI与DXA测定BMD有较好的相关性,QUS-T值及QUS-SI对诊断骨质疏松有一定的价值。桡骨不可替代跟骨作为QUS诊断骨质疏松症的检查部位。

Objective： To evaluate the diagnostic value of quantitative ultrasound test（QUS） in osteoporosis screening by comparing stiffness index（SI） calculated by QUS and bone mineral density（BMD） measured by dual energy X-ray absorptiometry（DXA） in hospital.To evaluate whether radius can substitute calcaneus as testing parts used in the diagnosis of osteoporosis by QUS.Methods：A total of 389 adult female from the First Affiliated Hospital of Shihezi University from October 2014 to December 2015 were recruited. BMD of lumbar spine（L1-L4） and femur neck measured by DXA and calcaneus SI calculated by QUS were observed.The correlation between SI and BMD measured by DXA（gold standard） were compared. Receiver operating characteristic curves（ROCs） were plotted and the areas under the curves（AUCs） for SI and T values compared between radius and calcaneus.Results：（1）In the normal group, there was different detection between SI calculated by QUS and BMD measured by DXA. In bone loss group, there was similar detection between SI of calcaneus and BMD. In the osteoporosis group, there was similar detection between SI of radius and BMD.（2）SI of calcaneus calculated by QUS had a good correlation with BMD measured by DXA（P〈0.01）,while SI of radius calculated by QUS had no obvious correlation with BMD.（3）Calcaneal QUS and radial QUS value to the diagnosis of osteoporosis： the area under the curve（AUC） of QUS-T for detecting OP was 0.837 with a sensitivity of 80.3% and a specificity of 75.4%,and the best cut-off value was-1.75.The area under the curve（AUC） of QUS-SI for detecting OP was 0.847 with a sensitivity of 80.3% and a specificity of 76%, and the best cut-off value was 74.50.QUS-T and QUS-SI of radius have no value for detecting osteoporosis.Conclusions：SI calculated by QUS had a good correlation with BMD measured by DXA. The high sensitivity and specificity of QUS made it as a diagnostic tool for osteopenia. QUS-T value and SI of calcaneus can be used as diagnostic indicators;radius can＇t be alternative as testing parts.