定量CT参数联合血生化指标对中老年人腰椎骨密度的评估

Evaluation of Lumbar Spine Bone Mineral Density in Middle-Aged and Elderly People by Quantitative CT Parameters Combined with Blood Biochemical Indexes

目的探讨定量CT(QCT)参数联合血生化指标与中老年人腰椎骨密度(BMD)的相关性。方法前瞻性纳入参加西南自然队列研究的受试者439例,将受试者按性别和年龄段(每隔10岁为1组)分4组,比较每组腰椎BMD,独立样本t检验比较不同性别两组的一般资料、血生化指标和QCT参数的差异。单因素方差分析比较骨量正常组、骨量减少组和骨质疏松组各项参数的差异。Pearson相关分析腰椎BMD与各个参数之间的相关性,多元线性回归分析腰椎BMD下降的危险因素。结果腰椎BMD随年龄增大逐渐降低。男性骨量减低组和骨质疏松组的高密度脂蛋白(HDL-C)高于骨量正常组,甘油三酯(TG)和皮下脂肪(SFA)低于骨量正常组(P<0.05)。女性骨量减低组和骨质疏松组腹内脂肪(VFA)和总脂肪(TFA)都高于骨量正常组(P<0.05)。男性腰椎BMD与年龄、HDL-C呈负相关,与体质指数(BMI)、TG、SFA呈正相关(P<0.05),女性腰椎BMD与年龄、HDL-C、VFA、TFA均呈负相关(P<0.05)。年龄和HDL-C是男性腰椎BMD异常的危险因素,BMI是其保护因素,年龄和VFA是女性腰椎BMD异常的危险因素。结论腹部脂肪堆积和血脂代谢异常是导致中老年人腰椎骨质疏松的重要影响因素。

Objective To investigate the correlation between quantitative computed tomography(QCT)parameters combined with blood biochemical indexes and bone mass density(BMD)of lumbar spine in middle-aged and elderly people.Methods Total 439 subjects were prospectively enrolled and divided into 4 groups according to gender and age(every 10 years as a group).The lumbar BMD of each group was compared,and differences of general information,blood biochemical indicators and QCT parameters between two groups of different genders were compared by independent sample t-test.One-way analysis of variance was used to compare difference of each parameter among normal bone mass group,osteopenia group and osteoporosis group.Pearson correlation was used to analyze the correlation between lumbar BMD and each parameter,and multiple linear regression was used to analyze risk factors of lumbar BMD decline.Results Lumbar BMD decreased with age.High-density lipoprotein cholesterol(HDL-C)in male osteopenia group and osteoporosis group were higher than those in normal bone mass group.Triglyceride(TG)and subcutaneous fat area(SFA)was lower than that of normal bone mass group(P<0.05).Visceral fat area(VFA)and total fat area(TFA)were higher in women with low bone mass and osteoporosis than those with normal bone mass(P<0.05).BMD of lumbar spine was negatively correlated with age,HDL-C,and positively correlated with body mass index(BMI),TG and SFA in males(P<0.05).BMD of lumbar spine was negatively correlated with age,HDL-C,VFA and TFA in females(P<0.05).Age and HDL-C were risk factors of abnormal lumbar BMD in male,while BMI was a protective factor.Age and VFA were risk factors of abnormal lumbar BMD in female.Conclusion Abdominal fat accumulation and dyslipidemia would be important factors leading to lumbar osteoporosis in middle-aged and elderly people.