绝经后妇女腰椎骨密度容积性定量CT测量研究

目的 应用容积性定量CT(vQCT)技术和双能X线吸收测量(DXA)仪测量绝经后妇女腰椎容积性骨密度(BMD),评价2种检查方法区分骨质疏松伴椎体骨折与骨质疏松不伴骨折的差异.方法 选取绝经后妇女118名平均年龄(62.1±7.0)岁],按照所行胸腰椎X线平片检查结果及腰椎DXA测量的参数前后位BMD(AP-SPINE)]值分组,>均值-1个标准差(x-1s)为正常组、x-1s～x-2s为骨量减少组、0.05).在骨质疏松组和骨质疏松伴骨折组AP-SPINE仅与3D-CORT间有相关性(R2=0.189,P<0.01);App60 BV/TV%、App80 BV/TV%、App100 BV/TV%、App120 BV/TV%与3D-TRAB或2D-TRAB之有相关性(3D法:R2值分别为0.955、0.951、0.941、0.912;2D法:R2值分别为0.912、0.910、0.878、0.821;P值均<0.01).容积性BMD的测量精确度为0.70%～2.25%.结论 vQCT技术可区分骨质疏松及伴骨质疏松性骨折绝经后妇女骨量,能力高于DXA,其中整体骨BMD诊断严重骨质疏松的效果最好;App BV/TV%可反映骨质疏松者骨小梁丢失程度,预测骨折风险.

Evaluation of bone mineral density measurement of lumbar vertebrae by volumetric quantitative CT in postmenopausal women

Objective To demonstrate the validity of volumetric QCT and dual energy X-ray absorptiometry( DXA )in bone mineral density (BMD) measurement and compare the difference in discriminating osteoporotic postmenopansal women with and without vertebral fracture. Methods One hundred and eighteen postmenopausal women mean age (62. 1 ± 7.0) years ] who received thoracolumbar radiographic examination were enrolled and divided into four groups (normal, osteopenia, osteoporotic and osteoporotic fractured group) also based on their BMD value of lumbar vertebra(AP-SPINE) measured by DXA: >x- 1s,x- 1s-x-2s, 0. 05 ]. In osteoporotic groups, AP-SPINE was not correlated significantly with other variables except 3D-CORT ( R2 = 0. 189, P < 0. 01 ) ; parameters of App60,80,100,120 BV/TV% were correlated significantly with 3 D-TRAB (R2 = 0. 955, 0. 951,0. 941,0. 912, P < 0. 01, respectively) and 2 D-TRAB(R2 = 0.912, 0.910, 0.878, 0.821, P < 0.01, respectively). The precision of 3D-BMD measurement was between 0. 70%--2. 25%. Conclusions Parameters derived from 3D-vQCT technique can discriminate osteoporotic postmenopausal women with fractured vertebrae from those without fractured vertebrae, and have better the capability than DXA. Among them, 3D-INTGL was the best parameter for diagnosing serious osteoporosis. App BV/TV% could be used to reflect the lost of trabecular bone precisely and to clinically predict fracture risk.