DXA技术测量股骨颈骨强度的临床研究

发布时间：2018-06-03 20:24

本文选题：双能X线吸收法 + 骨强度　；参考：《暨南大学》2013年博士论文

【摘要】：目的通过双能x线吸收法(DXA)重复测量的短期精密度试验来获取股骨颈骨强度(HSA)参数与身体成分参数的精密度,并计算相应误差的最小显著变化(LSC)。方法73名健康成年志愿者进行了双侧股骨近端的DXA HSA精密度试验,分别计算单、双侧股骨近端骨密度(BMD)和HSA测量参数[截面面积(CSA)、截面转动惯量(CSMI)、截面模量(Z)、皮质骨外径(PD)、皮质骨内径(ED)和皮质骨厚度(CT)]的精密度[以变异系数均方根(RM-CV%表示)]；50名健康成年志愿者进行了DXA全身扫描精密度试验,计算全身身体成分DXA测量参数[脂肪含量(FM)、瘦组织含量(LM)和骨矿物质含量(BMC)]的精密度(以RM-CV%表示)。并进一步计算出在95%的可信区间内所有测量参数误差值的最小范围(以LSC表示)。结果DXA单侧股骨颈测量中,HSA各参数RM-CV%在0.8～4.0%之间；双侧股骨颈测量中,HSA各参数的平均值RM-CV%在0.6～2.8%之间。双侧股骨颈测量HSA参数精密度较单侧测量提高了13～33%。身体成分测量精密度各参数RMS-CV%均在2%以下。结论采用DXA测量股骨颈HSA各参数和全身身体成分各参数的精密度较高,可以满足临床研究的需要。目的在进行了双能X线吸收法(DXA)左、右侧股骨颈骨强度(HSA)测量参数差异比较的基础上,应用HSA中的的骨强度参数和骨结构参数分析股骨颈生物力学在不同性别、不同年龄阶段以及不同骨折风险人群中的表现情况,探寻不同人群HSA参数随年龄增长而变化的结构和力学生物学基础。方法400名不同人群受试者的左、右侧股骨HSA测量参数分别采用配对t检验和Pearson相关分析比较两者之间的差异和相关性。分析了3855例男、女性人群代表股骨颈骨强度的HSA参数[截面面积(CSA)、截面转动惯量(CSMI)和截面模量(Z)]与年龄的相关性,比较人群不同阶段之间(中青年男性和老年男性；绝经前女性和绝经后女性)HSA参数[CSA、CSMI、Z、皮质骨外径(PD)、皮质骨内径(ED)和皮质骨厚度(CT)]的差异。对正常组、骨量减少组和骨质疏松组人群的HSA测量参数进行多样本比较的秩和检验,并应用两样本比较的秩和检验进一步分析了绝经后女性和老年男性人群HSA参数随年龄变化的趋势。结果双侧股骨颈HSA各参数之间均没有发现显著差异(p0.05),且呈高度正相关(r=0.801～0.921,p0.05)。老年男性和绝经后女性的CSA、CSMI和Z随年龄增长而显著下降(r=-0.183～-0.495,p0.05),而中青年男性和绝经后女性未发现与年龄增长的负相关关系。绝经后女性股骨颈骨CSA、CSMI和Z、CT低于绝经前女性,PD和ED未发现两组差异；老年男性股骨颈CSA、CSMI和Z和CT低于的中、青年男性,但PD和ED高于后者(p0.05)。老年男性和绝经后女性的CSA、CSMI和Z均随着骨折风险增加而降低,而且均随着年龄增长而降低,但是与股骨颈骨密度的下降趋势并不一致(p0.05)。结论左、右侧股骨颈之间的骨强度没有显著差异。在股骨颈骨量随着年龄的增加而减少的情况下,其强度也逐渐降低,但股骨颈通过骨的重建改变其截面的结构,存在对负荷减少以及对骨强度的维持的适应现象。目的本研究应用双能x线吸收法(DXA)分别在不同BMI阶段的成年男、女人群中分析股骨颈骨强度(HSA)与不同身体成分之间的关系。方法按世界卫生组织(WHO)体重指数标准将受试者分组,低体重组(BMI≤18.5)女性329人,男性109人；正常体重组(18.5BMI25)女性1850人,男性718人；超重组(25≤BMI30)女性482人,男性282人；肥胖组(BMI≥30)女性52人,男性33人。分别测量每组人群的骨密度(BMD)、全身瘦组织(LM)含量、脂肪组织(FM)含量、以及HSA参数[截面面积(CSA)、截面转动惯量(CSMI)和截面模量(Z)],每组间进行了HSA参数与身体成分参数的相关性分析和非配对t检验,并应用协方差分析对HSA参数进行了体重、FM和LM校正后的组间比较。结果低体重组的CSMI、CSA和Z较正常体重组低,而超重和肥胖组CSMI、 CSA和Z高于正常体重组(p0.05)。在各组中LM均都与CSMI、CSA和Z呈高度正相关(r=0.310～0.616,p0.05)。当经过LM校正后,男、女性低体重、超重、肥胖组的CSA、CSMI和Z与正常体重组无显著差异；当经过FM校正后,男、女性低体重、超重、肥胖组的CSMI、CSA和Z与正常体重组的统计学差异仍显著存在(p0.05)；当经过体重校正后,男性低体重、超重、肥胖组的CSA、 CSMI和Z与正常体重组无显著差异,女性低体重、超重、肥胖组的CSMI、CSA和Z与正常体重组的统计学差异仍显著存在(p0.05)。多元回归分析显示：成年男、女性各组中中LM都是显著变量,且LM的标准偏回归系数均高于FM。结论在成人男、女性人群中LM都是一个影响骨强度的决定因素,骨强度的高低主要是对LM所代表的动态负荷适应的结果。
[Abstract]:Objective to obtain the precision of the femoral neck bone strength (HSA) parameters and body component parameters by the short term precision test of double energy X-ray absorption (DXA) repeated measurement, and to calculate the minimum significant change of the corresponding error (LSC).
Methods 73 healthy adult volunteers were performed the DXA HSA precision test on the proximal femur of the femur. The accuracy of the single, bilateral femur proximal bone mineral density (BMD) and HSA parameters [cross section area (CSA), cross section inertia (CSMI), cross-section modulus (Z), cortical bone diameter (PD), cortical bone diameter (ED) and cortical bone thickness (CT)] were calculated. Number mean square root (RM-CV%)]; 50 healthy adult volunteers carried out a DXA whole body scan precision test to calculate the precision of the body composition DXA measurement parameters [fat content (FM), thin tissue content (LM) and bone mineral content (BMC)], and further calculated the error of all measurement parameters within the confidence interval of 95%. The minimum range of the value (as expressed in LSC).
Results in the measurement of DXA unilateral femoral neck, the parameters RM-CV% of HSA were between 0.8 and 4%. The average value of each parameter of HSA was from 0.6 to 2.8% in the bilateral femoral neck measurement. The precision of the HSA parameters of the bilateral femoral neck measurement was higher than that of the single side measurement, and the parameters RMS-CV% of the body composition of 13 to 33%. were less than 2%.
Conclusion using DXA to measure the parameters of femoral neck HSA and the parameters of whole body composition are more precise, which can meet the needs of clinical research.
Objective on the basis of the comparison of the differences in the measurement parameters of the left and right femoral neck bone strength (HSA) in the left and right femur (DXA), the performance of the biomechanics of the neck of the femur in different sex, different age stages and different bone fracture risk groups was analyzed by using the parameters of bone strength and bone structure in HSA, and the HSA parameters of different population were explored. The structural and biomechanics basis of number varies with age.
Methods the difference and correlation between the left and right femur HSA measurement parameters of 400 different subjects were compared with the paired t test and Pearson correlation analysis. The HSA parameters of the femoral neck bone strength (section area (CSA), cross section moment of inertia (CSMI) and section modulus (Z)) of the femur were analyzed in 3855 men and women. The difference between the HSA parameters [CSA, CSMI, Z, cortical bone diameter (PD), cortical bone diameter (ED) and cortical bone thickness (CT) between the different stages of the population (young and middle-aged men and elderly men; premenopausal women and postmenopausal women). The rank sum of the HSA measurement parameters in the normal group, the bone mass reduction group and the osteoporosis group was compared with the normal group. Test and apply the rank sum test of two samples to further analyze the trend of HSA parameters changing with age in postmenopausal women and elderly men.
Results there was no significant difference between the parameters of bilateral femoral neck HSA (P0.05), and there was a high positive correlation (r=0.801 to 0.921, P0.05). The CSA, CSMI and Z of the elderly and postmenopausal women were significantly decreased with age (r=-0.183 to -0.495, P0.05), while the negative correlation between young and postmenopausal women was not found in young and middle-aged men and postmenopausal women. Postmenopausal women with femoral neck bone CSA, CSMI and Z, and CT were lower than premenopausal women, PD and ED were not found in two groups; young men were lower than those of the femoral neck CSA, CSMI and Z and CT in the elderly male, but PD and ED were higher than those of the latter. The decrease was not consistent with the decreasing trend of femoral neck BMD (P0.05).
Conclusion there is no significant difference in bone strength between the left and the right femur neck. The strength of the femoral neck is gradually reduced with the increase of age, but the reconstruction of the femoral neck through the bone changes the structure of the cross section, and there is a reduction in the load and the adaptation to the maintenance of bone strength.
Objective to analyze the relationship between the bone strength of the femur (HSA) and the different body components in the adult male and female group at different BMI stages, respectively, by using the dual energy X-ray absorption (DXA) method.
Methods according to the WHO (WHO) body mass index standard, the subjects were divided into groups, 329 women with low body weight (BMI < 18.5), 109 men, 1850 women in normal weight group (18.5BMI25), 718 male, 482 women with 25 BMI30, 52 males and 33 men in obesity group (BMI > 30). The bone of each group was measured respectively. Density (BMD), body thin tissue (LM) content, adipose tissue (FM) content, HSA parameter [cross section area (CSA), cross section inertia (CSMI) and section modulus (Z)]. Each group carried out the correlation analysis of HSA parameters and body component parameters and unpaired t test, and used covariance analysis to carry on the weight, FM and LM correction group for HSA parameters. Compare with each other.
Results CSMI, CSA and Z were lower than normal weight groups, while CSMI, CSA and Z in overweight and obese groups were higher than normal weight group (P0.05). All LM in each group were highly correlated with CSMI, CSA and Z (r=0.310 ~ 0.616). After FM correction, there was a significant difference between male, female, low weight, overweight, obesity group, CSMI, CSA, and Z and normal weight group (P0.05). When body weight correction, male low weight, overweight, obesity group CSA, CSMI and Z and normal weight group have no significant difference, female low weight, overweight, obesity group CSMI, CSA and Z and positive. The statistical difference of the normal body recombination was still significant (P0.05). The multivariate regression analysis showed that the middle LM of the adult male and female groups were all significant variables, and the standard partial regression coefficients of LM were all higher than that of FM..
Conclusion in the adult male and female population, LM is a determinant of the bone strength, and the bone strength is the result of the adaptation to dynamic load represented by LM.
【学位授予单位】：暨南大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R310

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