双能X射线吸收法测量双侧股骨颈骨密度的差异及影响因素

Bone mineral density difference in bilateral femoral necks measured by dual-energy X-ray absorptiometry and its influencing factors

背景:应对骨质疏松症是中国应对人口老龄化的重要组成部分,骨质疏松的早期预防、早期发现及早期干预被认为在改善预后中起到非常重要的作用。目的:分析影响双侧股骨近端骨密度差异的相关因素,探讨提升双能X射线吸收法诊断效能的方法。方法:回顾性分析2021年1-7月在中山大学孙逸仙纪念医院核医学科进行双能X射线吸收法骨密度检查共207例受检者的临床资料,分组后分析组间差异性及导致差异性的相关因素,多元logistic回归方程校正,受试者工作特征曲线预测效能。结果与结论:①入组受检者个体双侧股骨颈骨密度的差异[高于最小有意义变化(LSC)]与左右利手、睡眠朝向偏好等无显著相关关系(P均>0.05);②对于绝经后女性及50岁以上男性,当左侧股骨颈T值为-0.9或-1.0时(且此时骨密度值与T值为-1.1时的骨密度值差值大于LSC)加做右侧检查则可明显提高骨量减少的诊断率(P<0.001),且经多元logistic回归分析校正传统因素后提示其为独立影响因素,OR=0.001,95%CI(0.000-0.326),P=0.03,受试者工作特征曲线预测其改变诊断的效能:曲线下面积=0.765,95%CI(0.536-0.993),P=0.018;③提示对于绝经后女性及50岁以上男性,当其左侧股骨颈T值为-0.9或-1.0时(且此时骨密度值与T值为-1.1时的骨密度值差值大于LSC),行腰椎+双侧股骨近端双能X射线吸收法骨密度检查较单侧检查可显著提高骨量减少的诊断率。

BACKGROUND:Coping with osteoporosis is an important part of China’s response to population aging.Early prevention,early detection and early intervention of osteoporosis were considered to play a very important role in improving prognosis.OBJECTIVE:To analyze the relevant factors affecting the difference in bone mineral density of bilateral proximal femur and to explore the methods to improve the diagnostic performance of dual-energy X-ray absorptiometry.METHODS:The clinical data of 207 subjects who underwent dual-energy X-ray absorptiometry bone mineral density examination in Department of Nuclear Medicine,Sun Yat-sen Memorial Hospital,Sun Yat-sen University from January to July 2021 were retrospectively analyzed.After grouping,differences between groups and related factors leading to differences were analyzed.Multivariate Logistic Regression Equation was utilized for correction.Receiver operating characteristic curve was used to predict performance.RESULTS AND CONCLUSION:(1)There was no significant correlation between the differences in the bone mineral density of the bilateral femoral necks(higher than the least significant change)and left-right handedness,sleep orientation preference(all P>0.05).(2)For postmenopausal women and men over the age of 50 years,when the left femoral neck T value was-0.9 or-1.0(the difference between the bone mineral density value and the bone mineral density value when the T value was-1.1 was greater than the least significant change),the right-side examination could significantly improve the diagnosis rate of osteopenia(P<0.001).Multivariate logistic regression analysis showed that it was an independent influencing factor after correcting traditional factors,OR=0.001,95%CI(0.000-0.326),P=0.03;receiver operating characteristic curve predicted its efficacy in altering the diagnosis:area under the curve=0.765,95%CI(0.536-0.993),P=0.018.(3)It is concluded that for postmenopausal women and men over 50 years old,when the T value of the left femoral neck was-0.9 or-1.0(the difference between the bone mineral density value and the bone mineral density value when the T value was-1.1 was greater than the least significant change),the dual-energy X-ray absorptiometry bone density test of the lumbar spine and bilateral proximal femur could significantly improve the diagnosis rate of bone loss compared with the lumbar and left side examination.