摘要
目的:分析DPX-MD双能X射线骨密度仪测量腰椎铝体模、活体腰椎、死体腰椎(带软组织)骨密度有临床意义的最小骨密度变化率差异,以便为重复测量同一个体的骨密度判断临床药物疗效、为骨密度检测质量控制和减少误差提供依据。方法:实验于2004-05/2005-10在川北医学院人体解剖实验室与川北医学院附属医院内分泌科骨密度室完成。椎体分类:①铝体模。②3个活体椎体:38岁骨密度正常男性的椎体;40岁骨质疏松症男性的椎体,但椎间隙清晰,无骨质增生;62岁轻微骨量减少女性的椎体,L2～4骨质增生,椎间隙欠清楚。③1个带软组织的死体椎体。3个活体椎体来源:38岁正常男性、40岁骨质疏松症男性与62岁轻微骨量减少女性均为自愿参与本实验的川北医学院附属医院医生;带软组织的死体椎体来源:川北医学院人体解剖实验室提供;铝体模来源:美国LUNAR公司生产的DPX-MD双能X射线骨密度仪所配备的自检模块。采用美国Lunar公司生产的DPX-MD双能X射线骨密度仪测量各椎体的骨密度。3次/d,连续测定5d。铝体模和死体椎体两端均用小木块固定在6.5cm的高度,放在15cm的水浴中,为减少误差由一人操作。由不同骨密度的变异系数可得到有临床意义的最小骨密度变化率,显著性水平设定为0.05则有临床意义的最小骨密度变化率为±2.8%,为0.1则有临床意义的最小骨密度变化率为±2.0%。结果:①各椎体和L2～4的骨密度值:铝体模和正常男性椎体的骨密度在正常范围,轻微骨量减少女性椎体有骨量减少,骨质疏松症男性椎体中度骨质疏松,死体椎体提示重度骨质疏松。②各椎体和L2～4的骨密度的变异系数:各椎体或L2～4骨密度变异系数从铝体模、正常男性椎体、骨质疏松症男性椎体、轻微骨量减少女性椎体与死体椎体呈依次增大,说明其精度逐渐变差。③各椎体有临床意义的最小骨密度变化率:铝体模最小,正常男性椎体较骨质疏松症男性椎体、轻微骨量减少女性椎体小,死体椎体最大。铝体模、正常男性椎体、骨质疏松症男性椎体、轻微骨量减少女性椎体与死体椎体L2～4有临床意义的最小骨密度变化率分别为±0.36%,±1.50%,±2.87%,±7.89%,±9.55%穴取95%的可信区间雪和±0.26%,±1.09%,±2.08%,±5.73%,±6.94%穴取90%的可信区间雪。结论:铝体模有临床意义的最小骨密度变化率最好,活体以骨密度正常者有临床意义的最小骨密度变化率较骨密度异常者好,死体最差。说明双能X射线骨密度仪测量不同条件椎骨有临床意义的最小骨密度变化率存在差异,其骨质疏松的严重程度不同骨密度检测对临床药物疗效观察的影响不同,骨质疏松越严重对其疗效观察影响越大。
AIM： To analyze the difference of rate of change of bone mineral density minimum with clinical significance after measuring bone mineral density （BMD） of aluminum model of lumbar vertebra, live lumbar vertebra, dead lumbar vertebra （with soft tissue） with DPX-MD dual-energy X-ray bone densometer, so as to provide evidence for repetitive measurement of BMD of the same individual, judging clinical curative effect of drug, quality control and reducing error of BMD determination.
METHODS： The experiment was performed at Laboratory of Human Anatomy, North Sichuan Medical College and Office of Bone Mineral Density, Department of Endocrinology, Hospital Affiliated to Noah Sichuan Medical College from May 2004 to October 2005. Classification of vertebral body： ①Aluminum model, ②3 live vertebral bodies： vertebral body of male with normal BMD of 38 years old; vertebral body of male with osteoporosis of 40 years old, but the intervertebral space was clear, no hyperosteogeny; vertebral body of female with slight reduction of bone mass of 62 years old, hyperosteogeny of L2-4, and intervertebral space was not clear. ③One dead vertebral body with soft tissue. Source of 3 live vertebral bodies： normal male of 38 years old and male with osteoporosis of 40 years old as well as female with slight reduction of bone mass of 62 years old, who were doctors of Hospital Affiliated to North Sichuan Medical College, were enrolled in the trial voluntarily. Source of dead vertebral body with soft tissue was provided by Laboratory of Human Anatomy, North Sichuan Medical College. Source of aluminum model： self-check die-block equipped by DPX-MD dual-energy X-ray bone densometer produced .by American LUNAR Company. BMD of each vertebral body was measured with DPXMD dual-energy X-ray bone densometer produced by American LUNAR Company, three times per day for 5 days. Double end of aluminum model and dead vertebral body were fixed at the height of 6.5 cm with small wood block, and then put into water bath with the height of 15 cm, for decreasing error the operation was done by one person. Rate of change of bone mineral density minimum with clinical significance could be gained by coefficient of variation of different BMD. The significant level was designed as 0.05, and the rate of change of bone mineral density minimum with clinical significance was ±2.8%; The significant level was designed as 0.1, the rate of change of bone mineral density minimum with clinical significance was ±2.0%. RESULTS： ①Value of BMD of each vertebral body and L2-4： BMD of aluminum model and normal male vertebral body was in the normal range. Bone mass of vertebral body reduced in female with slight reduction of bone mass. Vertebral body had moderate osteoporosis in male with osteoporosis, and dead vertebral body indicated severe osteoporosis. ② Coefficient of variation of each vertebral body and BMD of L2-4： The coefficient of variation increased from aluminum model, vertebral body of normal male, vertebral body of osteoporesis male, vertebral body of female with slight reduction of bone mass and dead vertebral body in order, which suggested that its precision became bad gradually. ③The rate of change of bone mineral density minimum with clinical significance of each vertebral body： That of aluminum model was the smallest; It was smaller in the vertebral body of normal male than that of vertebral body of osteoporosis male and vertebral booty of female with slight reduction of bone mass; That of dead vertebral body was the maximal. The rates of change of bone mineral density minimum with clinical significance of aluminum model, vertebral body of normal male, vertebral body of osteoporosis male, vertebral body of female with slight reduction of bone mass and vertebral body L2-4 of dead body were ±0.36%, ±1.50%, ±2.87%, ±7.89%, ±9.55% （95% confidence intertal） and ±0.26%, ± 1.09%, ±2.08%, ±5.73%, ±6.94% （90% confidence interval）, respectively. CONCLUSION： The rate of change of bone mineral density minimum with clinical significance of aluminum model is the best; It is better in live persons with normal BMD than that with abnormal BMD; That of the dead body is the worst. It is indicated that there is difference in rate of change of bone mineral density minimum with clinical significance of vertebra under different condition measured by dual-energy X-ray bone densometer. The influence of BMD detection on clinical curative effect observation of drug is different, for the different severe degree of osteoporesis. The more severe the osteoporesis, the great effect on curative effect observation is.
出处
《中国临床康复》
CSCD
北大核心
2006年第20期32-34,共3页
Chinese Journal of Clinical Rehabilitation
