【作者】 万超；

【导师】 邹季；

【作者基本信息】 湖北中医药大学 ， 中医骨伤科学， 2014， 博士

【摘要】 目的：利用双能X线吸收仪对十堰地区部分绝经后女性进行小样本的骨密度(BMD)测定,参照相关的骨质疏松症诊断标准对骨量进行分析,对参与试验者进行本地区骨质疏松症流行病学发病率的调查；对参与试验者的腰椎和股骨上端骨密度最小显著变化值(LSC)进行分析,提供临床医师作为判断骨质疏松症患者治疗成效及后续骨量变化的重要参考依据；同时根据腰椎和股骨上端骨密度测定结果,对上述部位骨密度之间的关系进行研究探讨,分析其在骨质疏松诊断上可能造成的差异；并对影响上述部位骨密度的个体因素予以分析,从中发现骨质疏松症发病的可调控因素,以便采取相应的干预措施,预防和延缓骨质疏松症的发生。方法：安排专业操作人员利用双能X线吸收仪,对100名符合纳入条件的十堰地区绝经后女性,同时进行两次腰椎和双侧股骨颈、股骨上端的扫描,根据骨密度测定结果,首先分析相关操作人员的精密度误差值,以观察是否符合国际临床骨密度协会(ISCD)提出的进行骨密度测定时的精密度误差标准,保证骨密度测定的准确率,以便为临床医师准确的诊断骨质疏松症提供可靠的参考依据；所得出的参与试验者的各部位骨密度最小显著变化值,可以提供临床医师作为判断骨质疏松症病人治疗成效及后续骨量变化的重要参考依据；参照世界卫生组织及国际临床骨密度协会发布的骨质疏松症诊断标准,对受试者进行本地区骨质疏松症流行病学发病率的调查；并对腰椎和两侧股骨颈、股骨上端各部位的T-score之间的关系进行研究分析,比较腰椎和股骨颈、股骨上端骨密度测定结果在骨质疏松症诊断水平上可能造成的差异；同时利用皮尔森相关分析法对各部位骨密度值与年龄、身高、体重及BMI指数之间的关系进行分析讨论,从中发现骨质疏松症发病的可能保护性因素。结果：参与本课题研究的两位操作人员平均精密度误差值：腰椎为0.008g/cm2,左侧股骨颈为0.013g/cm2,右侧股骨颈为0.016g/cm2,左侧股骨上端为0.007g/cm2,右侧股骨上端为0.007g/cm2。均符合国际临床骨密度协会(I SCD)所建议的精密度误差标准；在95%的可信区间下,得出受试者各检测部位的最小显著变化值,其平均值腰椎为0.022g/cm2,左侧股骨颈为0.035g/cm2,右侧股骨颈为0.045g/cm2,左侧股骨上端为0.020g/cm2,右侧股骨上端为0.019g/cm2。所参与研究的100名绝经后妇女中,参照世界卫生组织公布的骨质疏松症诊断标准,在腰椎、左侧股骨颈、左侧股骨上端、右侧股骨颈、右侧股骨上端存在骨量减少(-2.5<T-score<-1)和骨质疏松(T-score≤-2.5)的比例依次为64%、77%、62%、71%、63%；同时参照国际临床骨密度协会(ISCD)建议,100名绝经后妇女中“比实足年龄的骨矿物质密度低”(Z-score≤-2.0)的比例,在腰椎、左侧股骨颈、左侧股骨上端、右侧股骨颈、右侧股骨上端依次为64%、75%、67%、70%、65%。所检测出各部位的骨密度结果,通过统计学分析发现,腰椎的T-score与两侧股骨颈及与股骨上端的T-score有显著性差异(P<0.05),且认为腰椎的T-score值较高。而右侧的股骨颈及股骨上端的T-score与左侧股骨颈及股骨上端的T-score有显著性差异(P<0.05),且认为右侧比左侧为高。利用皮尔森相关系数分析表明参与研究者的年龄与所测量的各部位的骨密度值之间有低度的负相关,表明随着年龄的增大各部位的骨密度值有逐渐降低的趋势；而体重及BMI指数与以上测量部位的骨密度值有中度的正相关,表明体重及BMI指数越重(高),此部位的骨密度值越高。结论：双能X线吸收仪具有高精密度、扫描时间短、低辐射暴露以及稳定的校正效能,因而目前用来做为诊断骨质疏松症及追踪骨质疏松症治疗成效的黄金测量标准。本次调查的结果表明十堰地区绝经后女性骨质疏松症的发病处于较高水平；本次研究所获得的受试者各检测部位的骨密度最小显著变化值,可以提供临床医师作为判断骨质疏松症病人治疗成效及后续骨量变化的重要参考依据；鉴于腰椎及两侧股骨颈、股骨上端骨密度结果的差异性,建议临床医师在推荐患者进行骨密度测定时,如果能够一次性检查腰椎及两侧股骨上端(颈)三个部位,以便了解以上各部位骨密度之间的联系和差异,将为临床医师全面了解患者的骨量,做出综合诊断提供全面的参考依据；研究证实妇女绝经年龄与骨密度呈正相关,而绝经年限与骨密度呈负相关。体重及BMI指数与所测量部位的骨密度值有中度的正相关的关系,提示体重及BMI值是骨质疏松症的可能保护因素,通过维持适当的体重和BMI值对于预防和延缓骨质疏松症的发生有着积极的意义。更多还原

【Abstract】 Speciality:Orthopedics and Traumatology of TCMAuthor:Wan Chao Supervisor:Professor Zou JiObjective:By detecting small samples of bone mineral density of postmenopausal women in Shiyan city by using dual-energy X-ray absorptiometry, investigated the epidemiology of osteoporosis incidence for those participating in the trial, according to the diagnostic criteria for osteoporosis; By analysising the bone mineral density and the least significant change in the lumbar spine and proximal femurs, provided clinicians important reference for the outcome of the treatment and follow-up diagnosis as judged by patients with osteoporosis; According to differences of the bone mineral density in the lumbar spine and proximal femurs, analyzed the differences which may resulted in the diagnosis of osteoporosis;By analysising the individual factors which can affect the bone mineral density of those parts, found that the incidence factors of osteoporosis which can be regulated, so that we can take appropriate intervention measures to prevent and delay the occurrence of osteoporosis.Methods:Arranged professional operators use dual-energy X-ray absorptiometry to scan twice of lumbar spine and proximal femurs of100postmenopausal women,according to the results of the bone mineral density, analyzed the precision of operator error value, by compliance with the International Society for Clinical Densitometry (ISCD) BMD measurement precision error standard, to ensure the accuracy of measurement of bone mineral density, In order to provide a reliable reference for clinicians to accurately diagnose osteoporosis; Derived from participating in the trial, BMD least significant change in value, can provide important reference for clinicians as judged by patients with osteoporosis outcome of the treatment and follow-up diagnostic;Reference to the osteoporosis diagnostic criteria published by the World Health Organization and the International Society for Clinical Densitometry, made a epidemiological investigation of those people who participated in the trial;Compared the difference results in the diagnosis of osteoporosis caused by different T-score among the lumbar spine and both sides of femoral necks, proximal femurs;Analyzed the relationship between the various parts of the bone mineral density with age, height, weight and BMI index by Pearson correlation analyzed, and then found that protective factors of osteoporosis.Results:Analysised average precision error values of the two operators involved in the research:0.008g/cm2in the lumbar,0.013g/cm2in the left femoral neck0.016g/cm2in the right femoral neck,0.007g/cm2in the left proximal femur and0.007g/cm2in the right proximal femur. All results were in line with the precision errors of the standard recommended by the International Society for Clinical Densitometry (ISCD);Calculated the subjects of the respective detection parts of the least significant change values under the95%confidence interval:0.022g/cm2in the lumbar,0.035g/cm2in the left femoral neck,0.045g/cm2in the right femoral neck,0.020g/cm2in the left proximal femur, and0.019g/cm2in the right proximal femur;Reference to the World Health Organization published diagnostic criteria for osteoporosis, the presence of osteopenia and osteoporosis proportion of the100postmenopausal women who participated in the study:64%in the lumbar,77%in the left femoral neck,62%in the left proximal femur,71%in the right femoral neck,,and63%in the right proximal femur;Analyzed the T-score for100participants, and we found that the average T-score of lumbar spine was higher than both femoral necks and proximal femurs (p<0.05). and the average T-score of right hip was higher than left hip(p<0.05);Pearson correlation analyzed showed that there is a low negative correlation between bone mineral density and age, and a moderate positive correlation between bone mineral density and body weight and BMI index.Conclusions:As dual-energy X-ray absorptiometry has high precision, short scan time, low radiation exposure, and the stable performance of the correction, so it is used as a measurement of gold standard to diagnose osteoporosis and to track the effectiveness of osteoporosis treatment all over the world;The results of the survey showed that the incidence of osteoporosis at a high level in postmenopausal women in shiyan city;By analysising the bone mineral density least significant change in the trail, we can provide clinicians important reference for the outcome of the treatment and follow-up diagnosis as judged by patients with osteoporosis;In view of the test results of bone mineral density have differences among the lumbar spine and both sides of the proximal femurs, We suggest that we should measure not only the lumbar spine but also both proximal femurs in a clinical examination, In order to for clinicians understand the links and differences about BMD among those parts, and fully understand the patient’s bone mass, make a comprehensive diagnosis;We have confirmed the age and bone mineral density in postmenopausal women was positively correlated, and time of menopause was negatively correlated with bone mineral density. As Body weight and BMI index have a moderate positive correlation with bone mineral density, revealed that they are possible protective factors for osteoporosis, so it has a positive effect by maintaining proper weight and BMI values for the prevention and delay the occurrence of osteoporosis.更多还原