健康国人颈椎和腰椎体积骨密度的定量CT研究

目的 探讨国人健康成人颈椎和腰椎体积骨密度值(vBMD)分布情况。方法 采用横断面研究方法。2014年12月—2016年1月北京积水潭医院招募770名健康志愿者,其中男329名,女441名,年龄21～59岁。志愿者按年龄分为4组:A组(21～30岁)142人,B组(31～40岁)262人,C组(41～50岁)263人,D组(51～60岁)103人。采用日本TOSHIBA 128排CT机对志愿者行颈椎和腰椎定量CT扫描,并使用Mindways骨密度测量软件测量C₂～C₇、L₂～L₄椎体的vBMD值。采用单因素方差分析分别比较颈、腰椎中vBMD在不同性别、年龄组、节段的分布情况,男性、女性颈腰椎间各椎体vBMD的相关性采用Pearson相关分析。结果 男性志愿者C₂～C₇和L₂～L₄椎体vBMD分别为(288.40±60.63)、(275.71±56.33)、(283.91±59.62)、(278.95±53.76)、(253.38±49.99)、(217.94±44.96)和(151.64±31.74)、(145.22±31.77)、(147.16±35.81)mg/cm³,女性志愿者分别为(329.24±74.34)、(313.88±67.86)、(328.54±73.40)、(323.22±72.53)、(286.44±66.36)、(251.53±58.63)和(168.50±37.10)、(160.78±37.00)、(162.81±37.10)mg/cm³。无论男性还是女性,颈椎及腰椎的体积骨密度值均随着年龄增长而逐渐下降,差异均有统计学意义(P值均＜0.05)。男性志愿者同一年龄组内比较:C₂～C₇不同椎体的vBMD均呈下降趋势,差异均有统计学意义(P值均＜0.05);而L₂～L₄不同椎体的vBMD差异均无统计学意义(P值均＞0.05)。女性志愿者同一年龄组内比较:C₂～C₇不同椎体的vBMD均呈下降趋势,差异均有统计学意义(P值均＜0.05);D组L₂～L₄各椎体的vBMD均呈下降趋势,差异有统计学意义(P＜0.05),其他年龄组vBMD差异均无统计学意义(P值均＞0.05)。无论是男性或女性志愿者,在任何年龄组,颈椎vBMD均＞200 mg/cm³,腰椎vBMD值均＜200 mg/cm³,颈椎vBMD值均高于腰椎(P值均＜0.01)。男性、女性颈腰椎不同椎体间vBMD值均具有显著的相关性(r_男性=0.509～0.968, r_女性=0.658～0.976, P值均＜0.01);男性中,r_颈椎间=0.667～0.928,r_腰椎间=0.850～0.968,r_{颈椎与腰椎间}=0.509～0.675;女性中,r_颈椎间=0.754～0.933,r_腰椎间=0.956～0.973,r_{颈椎与腰椎间}=0.658～0.752;颈椎间或腰椎间vBMD相关系数均高于颈腰椎之间相关系数。结论 颈椎和腰椎vBMD在不同性别、年龄、节段分布存在差异,但各椎体vBMD均存在中-强相关性。本研究结果可为临床监测骨质疏松、评估骨折风险提供参考数据。

Quantitative CT study of volumetric bone mineral density of cervical vertebrae and lumbar vertebrae in healthy Chinese

Objective To investigate the distribution of volumetric bone density(vBMD)of cervical vertebrae and lumbar vertebrae in adult healthy Chinese.Methods A cross-sectional study method was used.From December 2014 to January 2016,770 healthy volunteers were recruited in Beijing Jishuitan Hospital,including 329 males and 441 females,aged 21-59 years.Volunteers were divided into 4 groups according to age:142 people in group A(21-30 years old);262 people in group B(31-40 years old);263 people in group C(41-50 years old);103 people in group D(51-60 years old).Quantitative CT scans of cervical and lumbar spine were performed on volunteers using a Japanese TOSHIBA 128-row CT machine,and the vBMD of C2-C7,L2-L4 were measured using Mindways bone density measurement software.In males and females,one-way analysis of variance was used to compare the differences of vBMD of the same vertebrae between different age groups,and between different vertebrae in the same age group,and to observe the distribution of vBMD in cervical and lumbar vertebrae in different genders,different age groups and different segments.Correlation analysis was conducted between the vBMD of different vertebrae in males and females,and the correlation degree of vBMD of each vertebrae was observed.Results In all male volunteers,the average vBMD values of the C2-C7 and L2-L4 vertebrae were(288.40±60.63),(275.71±56.33),(283.91±59.62),(278.95±53.76),(253.38±49.99),(217.94±44.96),(151.64±31.74),(145.22±31.77)and(147.16±35.81)mg/cm^3,respectively.In all female volunteers,the average vBMD values of the C2-C7,L2-L4 vertebrae were(329.24±74.34),(313.88±67.86),(328.54±73.40),(323.22±72.53),(286.44±66.36)、(251.53±58.63),(168.50±37.10),(160.78±37.00)and(162.81±37.10)mg/cm^3,respectively.Both males and females,the vBMD values of the cervical and lumbar vertebrae decreased with age,the differences were statistically significant(all P values<0.05).Among male volunteers,vBMD of C2-C7 vertebrae in the same age group showed a decreasing trend,and the difference was statistically significant(all P values<0.05).There was no significant difference in vBMD of the L2-L4 vertebrae(all P values>0.05).Among female volunteers,vBMD of C2-C7 vertebrae in the same age group showed a decreasing trend,and the difference was statistically significant(all P values<0.05).The vBMD of the L2-L4 vertebral showed a decreasing trend only in D group(P<0.05),while no significant difference in vBMD of other age groups(all P values>0.05).In both male and female volunteers,the vBMD values of cervical spine were more than 200 mg/cm^3,lumbar spine was less than 200 mg/cm^3,and cervical spine was higher than lumbar spine in any age group(all P values<0.01).There was significant correlation between vBMD values of different vertebrae in male and female(rmale=0.509-0.968,rfemale=0.658-0.976,all P values<0.01).In males,rintercervical=0.667-0.928,rinterlumbar=0.850-0.968,rcervical and lumbar=0.509-0.675.In females,rintercervical=0.754-0.933,rinterlumbar=0.956-0.973,rcervical and lumbar=0.658-0.752.The correlation coefficients of vBMD of intercervical and interlumbar were higher than those between cervical vertebra and lumbar vertebra.Conclusions The vBMD values of cervical and lumbar vertebrae are different in different genders,different age groups and different segments,but there are moderate to strong correlations between vBMD values of vertebrae.The results can provide reference data for clinical monitoring of osteoporosis and risk assessment of fracture.