【作者】 夏英毅；

【导师】 王撷秀；

【作者基本信息】 天津医科大学 ， 流行病与卫生统计学， 2004， 硕士

【摘要】 目的 为探索天津地区人群腰椎、股骨上端骨密度（BMD）随年龄变化的规律，为本地骨质疏松症（OP）的诊断和防治提供科学依据，从而提高天津地区骨质疏松防治水平。方法 笔者对天津地区20～79岁的1071人，采用美国NORLAND公司生产的XR-36双能X线骨密度检测仪测定腰椎(L_2-4)和股骨上端（Neck、Ward’s、Troch）的骨密度，按5岁为一年龄组，将其共分为12组。获取数据录入微机，应用SPSS软件数据库进行相关的统计分析。结果 腰椎L_2-4和股骨上端BMD峰值女性均见于35～39岁组，40岁以后BMD值随着年龄的增长而逐渐下降，50岁以后BMD值明显降低；男性峰值见于25～29岁组，30岁以后开始随年龄增长而下降，下降速度均匀而缓慢，但在60～64岁组出现一次较明显降低。各部位BMD累积丢失率无论男女均随着年龄增长而增加，且股骨上端BMD累积丢失率高于腰椎，在三个部位中BMD累积丢失率最高的是Ward’s三角区。女性各部位累积丢失率普遍明显高于男性。女性50岁以后可见骨量丢失加速，腰椎BMD累积丢失率在50岁后达9％～38％，股骨上端BMD累积丢失率最高的Ward’s三角在50岁以后达30％～50％。男性骨量丢失逐渐缓慢，但在60岁以后也有一个较快的丢失过程，其主要部位在股骨上端。以同性别、同部位峰值BMD减低两个标准差为诊断骨质疏松症的标准，男女股骨上端各部位骨质疏松检出率都明显高于腰椎。在49岁以前无论男性还是女性，骨质疏松症检出率均在10％以下，到50岁以后均随年龄的增长而增加。以累积丢失率最高的部位统计检出率，50岁以上女性约为30％～50％，男性15％～25％；60岁以上女性约为60％～80％，男性25％～40％；70岁以上女性达70％～90％，男性45％～55％。结论 骨质疏松的防治研究重点在于女性，特别是50岁以后的绝经妇女，但天津地区!071人骨密度研究硕士研究生论文对男性特别是老年男性也要同样重视。男性和女性股骨上端各部位BMD检测敏感性均高于腰椎，对于腰椎BMD检测正常而有明显骨质增生症状的患者，应参考股骨上端BMD检测值作出诊断，给出正确评价。更多还原

【Abstract】 Objective To study the changes of bone mineral density (BMD ) in people of Tianjin area and provide scientific basis for prevention and management of osteoporosis (OP) , so improve the level of OP prevention. Methods BMD of lumbar vertebrae (L2.4) , Femoral neck, Ward’s triangle and trochanters of 1 071 cases aged 20 - 79 was measured by NORLAND XR-36 dual energy X-ray absorptiometry made in USA. They were divided into 12 groups by every five years. All data were saved in the computer and statistical analyses were performed by SPSS 9.0 system for personal computers. Results The BMD peak values of lumbar vertebrae ( 1.2-4) , femoral neck, ward’s triangle and trochanters occurred in the age group 35-39 in females. BMD decreased with increasing age over 40, and considerately decreased in age over 50. The BMD peak values that for males seen in 25-29 years old group, BMD decreased with increasing age over 30, and it slower than females. But the evidence decreased in age 60-64. In both sexes, the rate of accumulative loss of BMD at different sites accelerated with increasing age. The rate of accumulative loss of BMD of femoral neck, ward’s triangle and trochanters were higher than that of lumbar vertebrae, and the highest rate in ward’s triangle. The rate of accumulative loss of BMD seemed higher for females than for males. The rate of loss was increased for females after 50 years old, and that of lumbar vertebrae was 9%-38% in age over 50. Of the three sites of the hip ( femoral neck, ward’s triangle and trochanters) ward’s triangle had highest rate of loss (30%-50%) in age over 50. The rate of accumulative loss of BMD in males was gradual, but there was also a rapid loss in age group of 60 at femoral neck, ward’s triangle and trochanters. 2s below the peak BMD are regarded as the diagnostic criterion of osteoporosis (OP). The detecting rate of osteoporosis (OP) in proximal femur was considerablely higher than that in lumbar vertebrae inmales and females. The morbidity of osteoporosis was less than 10% in both sexes before 49 years old, and after 50 that was increased with age. Statistics according to the most significant parts of the rate of accumulative loss of BMD, the detecting rate showed 30%-50% and 15%- 25% for females and males over 50years old respectively, 60%- 80% and 25%- 40% over 60, 70%- 90% and 45%-55% over 70 years old. Conclusion The investigation and prevention of osteoporosis is more important for females, especially for over 50 years old. As soon as, we should pay attention to males as well. The sensitivity of the detecting of BMD in the upper parts of proximal femur is higher than that in lumbar vertebrae. Patients with normal BMD of lumbar vertebrae, but with significant hyperosteogeny should be diagnosed as osteoporotic based on the BMD of the upper parts of femoral bone.更多还原