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.