腰椎前后位骨矿含量、面积评价骨密度测量的可靠性(英文)

Reliability of evaluation of human bone mineral density by estimation of the mineral content and area of lumbar bone in anteroposterior position

背景:针对双能X线前后位腰椎骨密度测定受腰椎骨质增生或压缩性骨折等因素的影响,易造成骨密度结果判断的误差,导致临床对骨质疏松症的漏诊、误诊。目的:通过对腰椎前后位骨密度、骨矿含量及面积相互关系的探讨,寻找正确评价骨密度可靠的相关依据。设计:前瞻性队列研究。地点和对象:实验由解放军总医院老年医学研究所完成。在北京市区选择20岁以上1567例健康人作为研究对象,其中男591例;女976例,职业包括军队和地方干部、教师、工人、居民。特殊职业者及患有各种影响骨代谢的急、慢性疾病者均除外。干预:按10岁为1个年龄段,将其分为8组。应用双能X线骨密度仪(DXA)进行腰椎骨密度、骨矿含量、面积的测定,确定不同性别平衡峰值期骨密度的年龄段、计算其骨矿含量及面积均值,以身高为自变量,骨密度为应变量分别作直线回归,建立骨矿含量、面积与身高的回归方程,利用其回归方程进行骨密度正常值的预报。主要观察指标:腰椎前后位骨密度、骨矿含量和面积。结果:平衡峰值骨密度的年龄,男性为20～49岁,女性为30～49岁;骨矿含量及面积的均值,男性分别为56.47g及46.39cm2,女性分别为47.418%及41.12cm2。90%正常范围:男性骨矿含量=0.327×身高(cm)±14.76,面积=0.271×身高(cm)±5.96,女性骨矿含量0.294×身高(cm)

BACKGROUND:As the test of dual energy X ray absorptiomety(DXA) of lumbar bone mineral density(BMD) in anteroposterior position could be influenced by lumbar hyperosteogeny,compression fracture,etc.,the error in the judgment of the result of BMD,could lead to missed diagnosis and misdiagnosis of osteoporosis. OBJECTIVE:To explore the reliable related evidence of correct evaluation through the study of the mutual relationship of BMD with bone mineral content(BMC)and area. DESIGN:A prospective cohort study was conducted. SETTING and PARTICIPANTS:The experiment was completed in the Institute of Geriatrics and Gerontology,General Hospital of Chinese PLA.Totally 1 567 cases of healthy persons over 20 years old in Beijing were selected as subjects.There were 591 males and 976 females.Their vocations include army or civil cadre,teacher,worker and urban resident.Persons with special vocations and with various acute and chronic disorders influencing the bone metabolism were excluded. INTERVENTIONS:Patients were divided into 8 groups with 10 years as the age difference between them.The BMD,mineral contents and area of lumbar vertebrae were tested with DXA to define the aging variation in the mineral density during equilibrium peak period of different gender groups.Mean mineral contents and area were calculated.Regression equation of mineral content,area and height was established with body height as the independent variance and BMD as the dependent variance to forecast the normal value of BMD. MAIN OUTCOME MEASURES:BMD of lumbar bone BMC and area in anteroposterior position. RESULTS:The age groups at equilibrium peak value stage were 20-49 years in men and 30-49 years in women respectively.The mean BMC and area were 56.47 g and 46.39 cm2 in men and 47.418 g and 41.12 cm2 in women respectively.For the 90 percent of normal range,BMC in males equals 0.327×height(cm)±14.76,area equals 0.271×height(cm)±5.96,and BMC in females equals 0.294×height(cm)±11.85,and area equals 0.225×height(cm)±5.00. CONCLUSION:Estimation of lumbar BMD only is not quite reliable.Both the lumbar BMC and area should be correctly evaluated to judge the reliability of estimated value of BMD.