男女腰椎及髋部骨密度在原发性骨质疏松症诊断中的价值探讨
发布时间：2018-11-21 10:16
【摘要】：背景及目的骨质疏松症(Osteoporosis,OP)是一种老年常见的疾病,是一种以骨量低下,骨微结构破坏,导致骨脆性增加和骨强度下降,易发生骨折、骨性炎症为特征的全身性骨病。而骨密度(bone mineral density,BMD)和骨质量(bone mineral content,BMC)则是反映骨强度的两个重要指标。流行病学调查显示,老年男女骨量减少患者随着年龄的增长而增多,预示着将来会有更多老年人患病。而骨密度(BMD)的测定对于OP的诊断、预防、治疗、并发骨折风险的评估有着重要的意义。本研究对比分析男女腰椎及髋部骨密度差异及相关性,并讨论在原发性骨质疏松诊断中的价值。研究方法选取2013年6月-2015年6月在浙江大学附属邵逸夫医院就诊的老年患者,均为浙江地区居民共300例,分为男女两组,其中男性103例,女性197例,分别统计病人基本信息,腰椎L1-L4及髋部各部位骨密度T值和发生骨质疏松,骨密度异常的个数,比较男女两组各部位BMD指标水平及相关性;比较OP及异常BMD的发生率;比较骨质疏松患者发病部位的分布。研究结果1.女性组腰椎L1、L2、L3、L4、L1-4、股骨颈、Wards区、全髋骨的骨密度水平明显低于男性组,差异有统计学意义(t分别=-9.42、-10.84、-10.66、…9.72、-11.05、-6.51、-8.95、-7.58,P 均0.001)。2.男女腰椎(L1-L4)椎体间BMD成正相关(r=0.684～0.927,p0.05);髋周骨BMD成正相关(r=0.825～0.848,p0.05);腰椎(L1-L4)与髋周骨BMD成正相关(r-0.339～0.666,p0.05)。3.男性OP检出率髋部(20.4%)高于腰椎(12.6%),女性OP检出率髋部(46.7%)低于腰椎(56.9%),差异无统计学意义(p0.05)。4.男女两组腰椎+髋部联合OP检出率分别为23.3%和69.5%,腰椎和髋部联合检查可以提高OP、BMD异常检出率(p0.05)。5.男女骨质疏松发生部位分布百分比不同,男性组OP患者,仅腰椎发生OP占12.5%,仅髋部占45.8%,腰椎+髋部同时发生OP占41.7%;女性组OP患者仅腰椎发生OP占32.8%,仅髋部18.2%,腰椎+髋部同时发生OP占47.9%。两组患者OP及BMD异常部位分布比较,差异存在统计学意义(p0.05)6.男性髋部BMD对OP诊断的敏感度较高,女性腰椎BMD对OP诊断的敏感度较高。研究结论:腰椎及髋部骨密度的测量对原发性骨质疏松的临床诊断至关重要,老年男性诊断原发性骨质疏松症可以首选测量髋部BMD,女性应同时检查腰椎与髋部BMD。如果条件允许,无论男女都应该同时做腰椎及髋部骨密度检查,提高诊断准确率。
[Abstract]:Background and objective Osteoporosis (Osteoporosis,OP) is a common disease in the elderly. It is characterized by low bone mass, destruction of bone microstructure, increase of bone brittleness and decrease of bone strength, prone to fracture and osteoinflammation. Bone mineral density (bone mineral density,BMD) and bone mass (bone mineral content,BMC (BMD) are two important indicators of bone strength. Epidemiological studies show that the number of older men and women with reduced bone mass increases with age, indicating that more elderly people will become ill in the future. The determination of bone mineral density (BMD) is of great significance in the diagnosis, prevention, treatment and assessment of fracture risk of OP. In this study, the difference and correlation of bone mineral density in lumbar spine and hip between men and women were analyzed, and the value of bone mineral density in diagnosis of primary osteoporosis was discussed. Methods from June 2013 to June 2015, 300 elderly patients were selected from the run Shaw Hospital, Zhejiang University. They were divided into two groups: 103 males and 197 females. The T value of bone mineral density (BMD) and the number of osteoporosis and abnormal bone mineral density (BMD) in lumbar L1-L4 and hip were compared between male and female. To compare the incidence of OP and abnormal BMD, and to compare the location of osteoporosis. Results 1. The bone mineral density (BMD) of lumbar vertebrae L1, L2, L3, L4 and L1-4, femoral neck, Wards area, total hip bone in female group was significantly lower than that in male group (t = -9.42% -10.84% -10.66, respectively). 9.72U -11.05U -6.51U -8.95U -7.58 (P = 0.001). There was a positive correlation between BMD in lumbar vertebrae (r = 0.684 / 0.927 / p0.05) and BMD in perihip bone (r = 0.825 / 0. 848 / p0.05) in male and female lumbar vertebrae (L1-L4). There was a positive correlation between lumbar vertebrae (L1-L4) and perihip BMD (r-0. 339 / 0. 666p. 05). 3. The detection rate of OP in male hip (20.4%) was higher than that in lumbar vertebrae (12.6%). The detection rate of female OP in hip (46.7%) was lower than that in lumbar vertebra (56.9%). There was no significant difference (p0.05). The detection rate of combined OP in lumbar spine and hip was 23. 3% and 69. 5%, respectively. The combined examination of lumbar spine and hip could increase the detection rate of OP,BMD abnormality (p 0. 05). In male group, only OP occurred in lumbar spine, 45.8% in hip and 41.7% in lumbar hip in male patients with OP. In female patients with OP, only OP occurred in the lumbar vertebrae (32. 8%), only in the hip (18. 2) and in the lumbar hip (47. 9%). There was a significant difference in the distribution of abnormal OP and BMD between the two groups (p0. 05). The sensitivity of male hip BMD to OP was higher than that of female lumbar BMD to OP. Conclusion: the measurement of bone mineral density of lumbar vertebrae and hip is very important for the clinical diagnosis of primary osteoporosis. Elderly men can choose to measure BMD, of hip at the same time. BMD. of lumbar vertebra and hip should be examined. If conditions permit, both men and women should do lumbar and hip bone mineral density examination to improve diagnostic accuracy.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R580
，
本文编号：2346681
[Abstract]:Background and objective Osteoporosis (Osteoporosis,OP) is a common disease in the elderly. It is characterized by low bone mass, destruction of bone microstructure, increase of bone brittleness and decrease of bone strength, prone to fracture and osteoinflammation. Bone mineral density (bone mineral density,BMD) and bone mass (bone mineral content,BMC (BMD) are two important indicators of bone strength. Epidemiological studies show that the number of older men and women with reduced bone mass increases with age, indicating that more elderly people will become ill in the future. The determination of bone mineral density (BMD) is of great significance in the diagnosis, prevention, treatment and assessment of fracture risk of OP. In this study, the difference and correlation of bone mineral density in lumbar spine and hip between men and women were analyzed, and the value of bone mineral density in diagnosis of primary osteoporosis was discussed. Methods from June 2013 to June 2015, 300 elderly patients were selected from the run Shaw Hospital, Zhejiang University. They were divided into two groups: 103 males and 197 females. The T value of bone mineral density (BMD) and the number of osteoporosis and abnormal bone mineral density (BMD) in lumbar L1-L4 and hip were compared between male and female. To compare the incidence of OP and abnormal BMD, and to compare the location of osteoporosis. Results 1. The bone mineral density (BMD) of lumbar vertebrae L1, L2, L3, L4 and L1-4, femoral neck, Wards area, total hip bone in female group was significantly lower than that in male group (t = -9.42% -10.84% -10.66, respectively). 9.72U -11.05U -6.51U -8.95U -7.58 (P = 0.001). There was a positive correlation between BMD in lumbar vertebrae (r = 0.684 / 0.927 / p0.05) and BMD in perihip bone (r = 0.825 / 0. 848 / p0.05) in male and female lumbar vertebrae (L1-L4). There was a positive correlation between lumbar vertebrae (L1-L4) and perihip BMD (r-0. 339 / 0. 666p. 05). 3. The detection rate of OP in male hip (20.4%) was higher than that in lumbar vertebrae (12.6%). The detection rate of female OP in hip (46.7%) was lower than that in lumbar vertebra (56.9%). There was no significant difference (p0.05). The detection rate of combined OP in lumbar spine and hip was 23. 3% and 69. 5%, respectively. The combined examination of lumbar spine and hip could increase the detection rate of OP,BMD abnormality (p 0. 05). In male group, only OP occurred in lumbar spine, 45.8% in hip and 41.7% in lumbar hip in male patients with OP. In female patients with OP, only OP occurred in the lumbar vertebrae (32. 8%), only in the hip (18. 2) and in the lumbar hip (47. 9%). There was a significant difference in the distribution of abnormal OP and BMD between the two groups (p0. 05). The sensitivity of male hip BMD to OP was higher than that of female lumbar BMD to OP. Conclusion: the measurement of bone mineral density of lumbar vertebrae and hip is very important for the clinical diagnosis of primary osteoporosis. Elderly men can choose to measure BMD, of hip at the same time. BMD. of lumbar vertebra and hip should be examined. If conditions permit, both men and women should do lumbar and hip bone mineral density examination to improve diagnostic accuracy.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R580
，
本文编号：2346681
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