双能X线吸收法及定量CT法诊断骨质疏松症的比较研究

本研究比较了双能Ｘ线吸法（ＤＸＡ）与定量ＣＴ（ＱＣＴ）在骨质疏松症诊断中的应用。对５６例健康妇女（Ｈ组）及４８例骨折后骨质疏松妇女（ＯＰ组）进行了ＤＸＡ及ＱＣＴ测量。ＤＸＡ与ＱＣＴ在Ｈ、ＯＰ组均显著相关（ｒ＝０．７５，Ｐ＜０．０００１，ｒ＝０．５８，Ｐ＜０．０００１）。Ｈ组及ＯＰ组，随年龄增长的骨减少率，ＱＣＴ较ＤＸＡ法为高。而两组中骨密度的差别，ＱＣＴ较ＤＸＡ法更大（Ｐ＜０．０５）。结论；由于ＱＣＴ可以选择性测量椎体松质骨，故可较ＤＸＡ更能很好地区分健康人与骨质疏松病人。     

定量超声和双能X线骨密度测定诊断骨质疏松的比较

目的通过对同一个人的跟骨超声强度（STI）测量与双能X线吸收法（DEXA）测量腰2-4、股骨近端骨密度（BMD）的临床对比,评价定量超声骨质测量仪（QUS）跟骨STI的测量,对诊断骨质疏松（OP）的敏感性和与DEXA测量BMD的相关性.方法对3266名20～89岁健康人群同时采用DEXA测量L2-4、右股骨近端（Neck、Ward、Troch）BMD和QUS测量右跟骨STI值进行相关分析.结果峰值骨量男性STI与BMD均出现在20～29岁,女性STI出现在20～29岁,BMD则出现在30～39岁;随年龄的增加腰椎、股骨近端BMD及超声强度均下降,女性在50岁后,男性在70岁后有个显著下降过程;OP检出率两种仪器无明显差异.在健康人中BMD与STI的相关系数（R=0.21-0.26）,骨质疏松患者BMD与STI的相关系数（R=0.14-0.24）.结论DEXA测量的BMD与QUS测量的STI无相关关系.这表明QUS主要测量骨的结构,而DEXA则是测量骨量的变化,两者相辅相承,共同测量能更好地监测骨质疏松、预测OP性骨折的发生.     

定量超声检测对绝经后骨质疏松症的应用价值

目的评价定量超声检测技术(QUS)对绝经后骨质疏松症的临床应用价值。方法 88例绝经后女性分别使用QUS测量左跟骨T值、双能X线吸收法(DXA)测量L1-4及髋部骨密度、T值,采用Spearman分析两种检测方法相关性。以DXA法诊断骨质疏松症(OP)为金标准,分析QUS诊断OP的ROC曲线下面积、cutoff、灵敏度、特异度、符合率、Youden指数。结果相关分析显示,QUS测量左跟骨与DXA测量L1、L2、L3、股骨颈、大转子、全髋T值相关系数分别为0.244、0.252、0.371、0.485、0.539、0.506(P0.05或P0.01);ROC曲线下面积0.669,以QUS测量T值-2.35为cutoff,QUS诊断OP的灵敏度、特异度、符合率、Youden指数分别为69.1%、65.0%、64.77%、0.341。结论 QUS与DXA检测骨密度存在相关性,可作为OP的筛查工具,但诊断效能一般,不可替代DXA检查。     

双能X线吸收法腰椎侧位骨密度测定的临床研究

目的评价双能X线吸收法测定腰椎骨密度时侧位的临床价值。方法178例女性患者(按年龄分组)接受腰椎后前位和侧位骨密度测定,以BMD表示骨密度值,以T值为标准判断骨量正常、骨量减少和骨质疏松,评价腰椎后前位与侧位T值对骨量减少程度的判断和骨质疏松诊断的差别。结果①各年龄组患者腰椎后前位BMD值均高于侧位值;②各年龄组患者腰椎后前位及侧位T值对骨量减少程度的判断有显著性差别;③当大于50岁时,腰椎后前位及侧位T值对骨质疏松诊断有显著性差别。结论腰椎侧位对女性患者骨量减少程度的判断和骨质疏松的诊断(>50岁)都有一定临床价值。     

双能X线吸收法测量身体成份精确度的研究

目的确定使用双能X线吸收法（DXA）在测定全身和局部身体成份短期精确度，以指导临床监测方案。方法对10名成年女性志愿者使用DXA（GE LUNAR PRODIGY型）骨密度仪进行了全身体成份测定。每名志愿者测量10次，每天重复5次分在2d（间隔不超过4d）中进行。志愿者测量期间饮食、运动等无明显改变，无腹泻等影响体重的疾病。每次测试需穿同样衣服，每次测量结束均离开骨密度仪，站到地面，下次测量再重新摆放体位。由同一名技师进行操作并分析。计算短期精确度。结果全身、上肢、大腿、躯干、男性区域及女性区域骨矿含量测定的变异系数（CV）分别为1．1％、1．5％、0．9％、2．8％、3．4％和1．7％，脂肪测定的CV分别为1．2％、3．5％、2．3％、2．7％、3．4％和1．8％，组织测定的CV分别为0．7％、1．4％、1．8％、1．6％、2．2％和1．4％，脂肪百分比的CV分别为1．2％、2．4％、1．1％、2．1％、2．3％和1．5％。结论全身体成份测定的CV在0．7％～1．2％，局部体成份测定的CV大部分在1％～2．5％之间。局部测定的精确度不如全身测定的精确度。全身测定和局部测定的精确度均可以满足临床和科研需要。     

绝经后中国女性跟骨定量超声和双能X线检查骨质疏松症的对比研究

目的观察绝经后中国女性跟骨定量超声和双能X线检查骨质疏松症的效果比较。方法评估234名绝经后未接受过治疗的40～80岁女性的腰椎、双侧股骨颈和全髋关节部位的骨密度(bone mineral density,BMD)的DXA参数和左右跟骨的QUS参数。计算BMD和QUS参数的相关系数。生成接收器操作特性曲线,并评估曲线下面积(area under curve,AUC)来定义QUS的截止值。结果跟骨QUS能够识别右侧髋关节(AUC,0. 887)和左股骨颈(AUC,0. 824)的T值为-2. 5或更低的绝经后妇女。为了筛选目的,定义了右侧(1. 455)和左侧(1. 480)跟骨的QUS T值的截止值。结论与DXA这种标准的诊断方法相比,可以推荐QUS作为预筛选工具来减少DXA筛查的数量。     

应用双能X线骨密度仪探讨糖尿病性骨质疏松症的影响因素

目的探讨2型糖尿病患者骨质疏松的影响因素。方法选择2011年9月至2013年3月在内分泌科住院的男性2型糖尿病患者209例为糖尿病组,选择同期体检的健康男性103例为对照组,应用双能X线骨密度仪(DXA)进行正位腰椎(L1-L4)及左侧股骨骨密度(BMD)测定,检测糖化血红蛋白(Hb A1C)、空腹血糖(FPG)及空腹C肽(CP),并进行统计学分析。结果糖尿病组骨量减少、骨质疏松发生率分别为14.35%、13.87%,明显高于对照组(P0.05)。两组检测者随着年龄增加,骨密度均呈下降趋势,50岁以上糖尿病患者腰椎及股骨颈骨密度均明显低于同龄对照组(P0.05)。糖尿病组骨密度多因素相关性分析显示,糖尿病患者骨密度与年龄、病程、Hb A1C呈显著负相关(P0.05),而与体重指数(BMI)、空腹C肽(CP)呈显著正相关(P0.05)。结论 2型糖尿病患者骨量减少及骨质疏松发生率较健康体检者明显升高;高龄、病程长及血糖控制不良是糖尿病患者BMD降低的危险因素。     

两种双能X线吸收法骨密度仪测量骨块模型的精密度和灵敏度比较

目的　了解扇形束 (HologicQDR 450 0A)和笔形束 (LunarDPX IQ)DXA骨密度仪测量结果之间的关系 ,探讨两者的数据换算关系。方法　 1 6个骨块模型分别在HologicQDR 450 0A型和Lu narDPX IQ型DEXA仪上测量 3次 ,比较两者的灵敏度。选取其中 3个骨块模型连续测量 2 0次求变异系数 ,比较两仪器的批内精密度。每天测 5次连续 2 0d求变异系数 ,比较两仪器的批间精密度。人体腰椎骨块模型每天测 5次连续 8d,建立两仪器之间数据换算关系。结果　 (1 )LunarDPX IQ型DEXA仪的灵敏度高于HologicQDR 450 0A型DEXA仪。 (2 )用小动物软件测量BA、BMC、BMD ,HologicDEXA仪的批内精密度分别为 0 57%、0 8%、1 1 % ;LunarDPX IQ型DEXA仪分别为 2 2 %、1 0 0 %、1 0 4%。HologicDEXA仪的批间精密度分别为 1 2 %、2 8%、2 4% ;LunarDPX IQ型DEXA仪分别为2 0 %、1 0 3 %、1 0 5 %。结果均显示HologicDEXA仪的精密度高于LunarDEXA仪。 (3)两仪器之间的BA、BMC、BMD绝对值差异明显 (P <0 0 5) ,但可用线性回归方程进行数据换算 :①BMD :Hologic值 =0 80 2×Lunar值 +0 31 8(r=0 991 ;P <0 0 0 1 ;SEE =0 0 3g/cm2 ) ;②BMC :Hologic值 =1 2 0×Lunar值 +1 685(r=0 984;P <0 0 0 1 ;SEE =0 81 6g) ;③BA     

双能X线吸收法骨密度测定

骨质疏松作为老年人的常见病之一 ,越来越受到社会各界的关注。骨密度测量是明确骨质疏松的诊断、估计骨质疏松的程度、评价骨质疏松的疗效[1 ] 的必要手段。随着骨密度测量技术的发展 ,越来越多的精确度和准确度越来越高的骨密度测量方法问世。双能Ｘ线吸收法 (ＤＸＡ)以其准确度和精确度高、辐射剂量低、扫描时间短、调节稳定等优点广泛地应用于临床[2 ] 。本文就ＤＸＡ测定方法有关内容进行综述 ,供广大临床工作者参考。ＤＸＡ的工作原理ＤＸＡ用Ｘ线管代替同位素产生独立的双能量光子 ,通过单独测量这两种能量光子的吸收情况 ,计算出骨…     

定量超声与双能骨密度测定在骨质疏松诊断中的应用及评价

目的观察定量超声法(QUS)在骨质疏松诊断中的意义及双能X线骨密度测定法(DEXA)在骨结构评价中的作用.方法采用Osteospace定量超声跟骨测定仪及HologicQDR4500A型双能骨密度测定仪,对40例健康体检者同时测定跟骨超声声速(SOS)、声衰减(BUA)以及全身、正位腰椎、侧位腰椎、侧位腰椎感兴趣区、股骨近端骨密度(BMD).结果BUA、SOS与大多数部位BMD相关关系显著(r=0.35～0.62,P<0.05或P<0.01);股骨近端及正位腰椎2BMD与BUA及SOS的直线回归关系显著(P<0.05).结论QUS是诊断骨质疏松和评价骨强度的良好方法.在DEXA测定部位中,股骨近端及正位腰椎2BMD有较高的评价骨结构特性价值.     

Correlations of dual-energy X-ray absorptiometry,quantitative computed tomography,and single photon absorptiometry with spinal and non-spinal fractures

Controversy continues as to which method of measuring bone mineral density (BMD) best detects osteoporosis and best correlates with fractures of the spine, hip and elsewhere. To answer these questions the prevalence of fractures was carefully determined among 90 subjects (70 with osteoporosis, 6 with mild primary hyperparathyroidism, 1 with osteomalacia and 13 normals) and simultaneous measurements were made using spinal computed tomography (QCT), spinal anteroposterior (AP) and supine lateral dual X-ray absorptiometry (DXA), femoral neck and total hip DXA, and distal third radial DXA and single photon absorptiometry (SPA). The DXA measurements which had the greatest sensitivity in detecting osteoporosis (defined as a BMD lower than –2.5 SD of peak bone mass at age 30 years) were the supine lateral spine DXA (84%) and femoral neck DXA (75%); less sensitive were the DXA measurements of the distal third of the radius (61%) and AP spine (51%). DXA measurements of the femoral neck and distal third of the radius were more useful than spinal measurements in detecting the osteopenia of mild primary hyperparathyroidism. Vertebral compression fractures (VCF) correlated well with spinal QCT (r=–0.38) and lateral spine DXA (r=–0.41), but poorly with AP spine DXA (r=–0.17) and distal third radial DXA (r=–0.02). Non-spinal fractures correlated best with the distal third radial DXA (r=–0.42). In conclusion, spinal QCT, supine lateral spine DXA and femoral neck DXA are the best BMD methods to screen for osteoporosis, whereas AP spine DXA is a poor screening method in women over 60 years of age. Spinal QCT and lateral spine DXA correlate well with VCFs, whereas correlations of VCFs with AP spine DXA, femoral neck DXA and distal third radial DXA are poor.     

Comparative assessment of bone mineral density of the forearm using single photon and dual X-ray absorptiometry

Summary Forearm bone mineral density (BMD) was measured at proximal and distal sites by ¹²⁵I single photon absorptiometry (SPA) and by dual energy X-ray absorptiometry (DXA) in 67 consecutive subjects, aged 18–75 years. Correlations and regression equations between these two techniques were determined. All forearm measurements were significantly correlated with each other (r=0.599–0.926; P0.0001). Although SPA and DXA correct for fat in different ways, we found similar correlation and regression equations in women with body mass index measurements above and below the mean. In addition, forearm measurements by both techniques were moderately correlated with vertebral spine and hip BMD. We conclude that overall, SPA forearm measurements in a population can be calibrated to DXA measurements if necessary, and that DXA forearm measurements are as predictive of the remainder of the skeleton as SPA measurements.     

A comparison of quantitative dual-energy radiographic absorptiometry and dual photon absorptiometry of the lumbar spine in postmenopausal women

Summary Noninvasive bone densitometry is an important aspect in the detection and management of osteoporosis and other forms of metabolic disease of calcified tissue. A system using quantitative dual-energy digital projection radiography (QDR) of the lumbar spine was systematically tested against dual-photon absorptiometry (DPA) of the lumbar spine in 131 women over 55 years of age and free from major risk factors for osteoporosis. All subjects were scanned by both QDR and DPA under the same conditions. Measurements for a given subject were made within 15 minutes of each other. Bone mineral densities (BMD) were determined for four individual levels in the lumbar spine (L1-L4). Regression equations for BMD vs. age, height, and weight were calculated. The results of this investigation indicate that DPA- and QDR-derived BMD values are comparable. BMD values derived by QDR were consistently lower than those obtained by DPA (DPA=1.115 QDR+0.137, r=0.942). The L2 lumbar region was the most strongly correlated determination.     

桡骨单光子骨密度测定与跟骨X射线摄片诊断骨质疏松比较

目的 了解、比较桡骨单光子骨密度测定与跟骨X射线摄片两种方法在骨质疏松诊断中的作用。方法 髓机抽取546名(女267名,男279名)45岁以上中老年知识分子做非优势侧桡骨单光子骨密度测定与跟骨X射线摄片,分析桡骨骨密度(BMD)及跟骨小梁Jhamaria分级的相关性;比较两种方法的诊断一致性,结果 ①桡骨BMD及跟骨Jhamaria分级均随年龄增长而逐渐下降。②跟骨Jhamaria分级越高。桡骨BMD也越高,两的相关性女性为0o．380(P=0．0001);男性为0．150(P=0．011)。③桡骨BMD低于峰值-2SD的女性,跟骨Jhsmaria分级1～2级占61．8%,4～5级占3．5%,男性分别为31．4%和7%;跟骨小梁Jhmaria分级1～2级的人群中,63．5%的女性桡骨BMD<峰值-2SD,男性仅为39．7％;④分别以桡骨BMD低于峰值-2SD和跟骨Jhamaria分级1～2级分别作为骨质疏松诊断标准,女性组的诊断一致性(Kappa值)为0．338,男性组仅为0．108。结论 女性人群的跟骨小梁Jhamaria分级与桡骨BMD有较好的相关性,两的变化在一定程度上可相互映证,而男性这种关系不明显。由于桡骨单光子测定主要反映皮质骨密度改变,跟骨Jhamaria分级主要反映跟骨小梁形态结构改变。因此,单独用其中一种方法进行骨质疏松诊断是不全面的,尤其对于男性人群,结合两种方法可能有助提高诊断效果。     

Screening for osteoporosis: Comparison between dual energy X-ray absorptiometry and broadband ultrasound attenuation in 1000 perimenopausal women

This paper compares dual-energy X-ray absorptiometry (DXA) of the spine and hip and broadband ultrasound attenuation (BUA) of the os calcis in 1000 perimenopausal women aged between 45 and 49 years who attended a randomized Osteoporosis Screening Programme. Significant correlations were found between all DXA results and BUA, with the trochanter giving the best numerical correlation with BUA (r=0.354,p<0.0001). BUA was not successful in predicting women with low DXA measurements, with only 44.0% of the women whose spinal DXA falls within the lowest quartile being in the lowest quartile of BUA. Although BUA is a poor predictor of spinal and hip bone mineral density it may provide additional structural information important in fracture prediction.     

胫骨定量超声测量及临床应用探讨

用ＳｏｕｎｄＳｃａｎ２０００骨定量超声（ＱＵＳ）仪测量胫骨超声速度（ＳＯＳ），同时与单光子吸收法（ＳＰＡ）测量前臂１／３处骨矿密度（ＢＭＤ）比较。两方法测得２０８例患者和健康志愿者结果相关（ｒ＝０．６７８，Ｐ＜０．００１）。４２例健康绝经妇女ＳＯＳ和ＢＭＤ与绝经时间呈负相关（ｒ＝－０．４１７和－０．４７９，Ｐ＜０．０１），７３例＞４０岁的健康志愿者ＳＯＳ和ＢＭＤ与年龄呈负相关（ｒ＝－０．２９３和－０．３７３，Ｐ＜０．０５）。与性别和年龄相匹配的正常参考值比较，结果＜ｘ－２ｓ者ＱＵＳ检出３４例，占１６．３％；ＳＰＡ２３例，占１１．０％，ＱＵＳ的诊断敏感度约是ＳＰＡ的１．５倍。