佛山市成年居民骨密度CT定量研究

吴伟智; 方挺松; 梁振华; 祝翠玲; 周静仪

doi:10.15953/j.ctta.2023.098

佛山市成年居民骨密度CT定量研究

doi: 10.15953/j.ctta.2023.098

佛山市中医院放射科, 广东佛山528000

基金项目: 2022年佛山市自筹经费类科技创新项目入库培育项目（2220001004568）；佛山市“十四五”医学重点专科项目（FSZD145011）。

详细信息

通讯作者:
男，硕士，佛山市中医院放射科副主任医师，主要研究方向为骨关节系统疾病的影像诊断与人工智能影像组学，E-mail：success2@163.com

计量
- 文章访问数: 33
- HTML全文浏览量: 20
- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2023-04-24
- 修回日期: 2023-07-28
- 录用日期: 2023-07-28
- 网络出版日期: 2023-08-09

Quantitative CT Study of Bone Mineral Density for Adults Residents in Foshan

Department of Radiology, Foshan Hospital of TCM, Foshan 528000, China

摘要

摘要: 目的：研究佛山地区成年人椎体骨密度（BMD）与性别、年龄的关系，探讨本地区不同年龄段BMD均值及各年龄段骨质疏松症（OP）的发病率。方法：对佛山市中医院2021年10月至2023年3月的1065例（男性648例，女性417例）健康成年人体检者使用定量C（QCT）行椎体BMD检测，按年龄段进行分组，采用t检验和方差分析对不同性别、不同年龄段BMD值进行检验，采用$\chi^2 $检验和相关分析对不同性别、不同年龄段的OP发病率进行分析。结果：20～29岁、30～39岁、40～49岁及60～69岁、70～79岁不同性别间的BMD差异均有统计学意义（P<0.05），女性BMD在青中年时期高于男性。在40～49岁、50～59岁、60～69岁、70～79岁男性组及30～39、40～49岁、50～59岁、60～69岁女性组中，同性别不同年龄段间的BMD值差异有统计学意义（P<0.05），且随年龄的增长呈下降趋势；同性别不同年龄段的OP发病率差异均有统计学意义（P<0.05），年龄与OP发病率呈正相关关系（r_男=0.517，r_女=0.636）。结论：佛山市健康成年人QCT测量的椎体BMD与性别、年龄相关，在20～29岁达到峰值，随年龄的增长而下降；从40～49岁开始，OP发病率在男性和女性中随着年龄的增长而增加。
- 成年人 /
- 定量CT /
- 骨密度 /
- 骨质疏松症 /
- 年龄 /
- 性别 /
- 相关性
Abstract: Objective: To study the relation between adult vertebral bone mineral density (BMD) and gender and age in Foshan, to explore the average BMD of each age group and osteoporosis (OP) incidence distribution in the region. Methods: Quantitative CT (QCT) was used to examine and record the vertebral BMD of 1065 (male 648, female 417) healthy adults who underwent physical examination in Foshan Hospital of TCM from October 2021 to March 2023, and grouped according to age, T test and variance analysis were used on BMD in different sex and age group. Chi square analysis and correlation analysis were used on the incidence of OP in different sex and age group. Results: There was significant difference in the BMD between male and female of 20～29, 30～39, 40～49 and 60～69, 70～79 years old (P<0.05), women had higher peak BMD than man in young to middle age. In the male groups of 40～49、50～59, 60～69, 70～79 and female groups of 30～39, 40～49, 50～59, 60～69 years old, there were also significant differences in BMD in different age groups of the same sex, and decreased with age. There was significant difference in the incidence of OP between different age groups (P<0.05) in the male and female groups. Age was positively related to the incidence of OP (r=0.517 for male and r=0.636 for female). Conclusion: The vertebral BMD derived from QCT for healthy adults in Foshan are associated with sex and age, peaked at 20～29 years old, and decreased with age. The incidence of OP for male and female increased with age from 40～49 years old.
- adults /
- quantitative CT (QCT) /
- bone mineral density (BMD) /
- osteoporosis (OP) /
- age /
- gender /
- correlation

HTML全文

图 1 椎体骨密度QCT测量方法

QCT测量的是椎体中央骨松质的体积骨密度，兴趣区避开骨皮质、骨岛和椎体后静脉区；其测量结果不受身高体重、脊柱侧弯、退变和血管钙化等因素的影响。

Figure 1. Measurement of vertebral bone mineral density by QCT

下载: 全尺寸图片幻灯片

表 1 1065例健康成年人胸部CT体检者椎体BMD分析（$\bar x \pm s $，mg/cm³）

Table 1. Analysis of vertebral BMD in 1065 healthy adults undergoing chest CT examination

年龄组/岁	男性		女性		t	P
年龄组/岁	人数/例	BMD	人数/例	BMD	t	P
20～29	41	163.31±26.28	21	188.38±28.79	-3.442	0.001
30～39	93	160.62±26.86	64	172.42±29.21^b	-2.61	0.01
40～49	168	145.47±29.67^a	97	158.05±32.5^b	-3.211	0.001
50～59	211	127.1±28.72^a	127	127.95±38.05^b	-0.215	0.83
60～69	79	107.54±29.85^a	67	92.36±25.64 b	3.263	0.001
70～79	40	96.11±23.6^a	25	84.43±18.11	2.114	0.038
80～89	16	91.51±26.78	16	77.38±17.21	1.775	0.086
F	56.893		74.37
P	<0.001		<0.001
注：a表示在男性组中，该年龄段与前一年龄段比较P<0.05；b表示在女性组中，该年龄段与前一年龄段比较P<0.05。

下载: 导出CSV

表 2 1065例健康成年人胸部CT体检者骨质疏松筛查结果[例（%）]

Table 2. Screening results of osteoporosis in 1065 healthy adults undergoing chest CT examination

年龄组/岁	男性				女性
年龄组/岁	正常	低骨量	OP	严重OP	正常	低骨量	OP	严重OP
20～29	38（92.68）	3（7.32）	0（0）	0（0）	21（100）	0（0）	0（0）	0（0）
30～39	90（96.77）	3（3.23）	0（0）	0（0）	61（95.31）	3（4.69）	0（0）	0（0）
40～49	137（81.55）	29（17.26）	1（0.6）	1（0.6）	85（87.63）	11（11.34）	0（0）	1（1.03）
50～59	125（59.24）	68（32.23）	13（6.16）	5（2.37）	68（53.54）	41（32.28）	12（9.45）	6（4.72）
60～69	25（31.65）	39（49.37）	13（16.46）	2（2.53）	8（11.94）	35（52.24）	22（32.84）	2（2.99）
70～79	4（10）	23（57.50）	11（27.50）	2（5）	1（4）	11（44）	10（40）	3（12）
80～89	2（12.5）	7（43.75）	4（25）	3（18.75）	0（0）	4（25）	10（62.5）	2（12.5）
$\chi^2 $	225.201				235.748
P	<0.001				<0.001

下载: 导出CSV

参考文献(33)

[1]	Consensus development conference: Diagnosis, prophylaxis, and treatment of osteoporosis[J]. American Journal of Medicine, 1993, 94(6): 646-650. DOI: 10.1016/0002-9343(93)90218-E.
[2]	中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊疗指南(2022)[J]. 中国全科医学, 2023,26(14): 1671−1691. doi: 10.12114/j.issn.1007-9572.2023.0121 Chinese Society of Osteoporosis and Bone Mineral Research. Guidelines for the diagnosis and treatment of primary osteoporosis (2022)[J]. Chinese General Practice, 2023, 26(14): 1671−1691. (in Chinese). doi: 10.12114/j.issn.1007-9572.2023.0121
[3]	程晓光, 王亮, 曾强, 等. 中国定量CT(QCT)骨质疏松症诊断指南(2018)[J]. 中国骨质疏松杂志, 2019,25(6): 733−737. doi: 10.3969/j.issn.1006-7108.2019.06.001 CHENG X G, WANG L, ZENG Q, et al. The China guideline for the diagnosis criteria of osteoporosis with quantitative computed tomography (QCT)(2018)[J]. Chinese Journal of Osteoporosis, 2019, 25(6): 733−737. (in Chinese). doi: 10.3969/j.issn.1006-7108.2019.06.001
[4]	中华医学会放射学分会骨关节学组, 中国医师协会放射医师分会肌骨学组, 中华医学会骨科学分会骨质疏松学组, 等. 骨质疏松的影像学与骨密度诊断专家共识[J]. 中国骨质疏松杂志, 2020,26(9): 1249−1256. doi: 10.3969/j.issn.1006-7108.2020.09.001 Bone and Joint Group of Chinese Society of Radiology, Chinese Medical Association, Musculoskeletal Radiology Society of Chinese Medical Doctors Association, et al. Consensus on the diagnosis of osteoporosis by imaging and bone mineral density measurement[J]. Chinese Journal of Osteoporosis, 2020, 26(9): 1249−1256. (in Chinese). doi: 10.3969/j.issn.1006-7108.2020.09.001
[5]	WANG L H, YU W, YIN X J, et al. Prevalence of osteoporosis and fracture in China: The China osteoporosis prevalence study[J]. JAMA Network Open, 2021, 4(8): e2121106. DOI: 10.1001/jamanetworkopen.2021.21106.
[6]	中国疾病预防控制中心慢性非传染性疾病预防控制中心, 中华医学会骨质疏松和骨矿盐疾病分会. 中国骨质疏松症流行病学调查报告(2018)[M]. 北京: 人民卫生岀版社, 2021.
[7]	王刚, 龙翔宇. 佛山市居民骨质疏松认知情况调查分析[J]. 按摩与康复医学, 2015,(24): 155−156.
[8]	中国健康促进基金会基层医疗机构骨质疏松症诊断与治疗专家共识委员会. 基层医疗机构骨质疏松症诊断和治疗专家共识(2021)[J]. 中国骨质疏松杂志, 2021,27(7): 937−944. doi: 10.3969/j.issn.1006-7108.2021.07.001 Expert Consensus Committee on Diagnosis and Treatment of Osteoporosis in Grassroots Medical Institutions of China Health Promotion Foundation. Expert consensus on the diagnosis and treatment of osteoporosis in primary medical institutions (2021)[J]. Chinese Journal of Osteoporosis, 2021, 27(7): 937−944. (in Chinese). doi: 10.3969/j.issn.1006-7108.2021.07.001
[9]	KENDLER D L, BAUER D C. DAVISON K S, et al. Vertebral fractures: clinical importance and management[J]. American Journal of Medicine, 2016, 129(2): 221.e221−210. DOI: 10.1016/j.amjmed.2015.09.020.
[10]	SIRIS E S, ADLER R, BILEZIKIAN J, et al. The clinical diagnosis of osteoporosis: A position statement from the National Bone Health Alliance Working Group[J]. Osteoporos International, 2014, 25(5): 1439−1443. DOI: 10.1007/s00198-014-2655-z.
[11]	中国康复医学会骨质疏松预防与康复专业委员会. 骨质疏松性椎体压缩骨折诊治专家共识 (2021版)[J]. 中华医学杂志, 2021,101(41): 3371−3379. doi: 10.3760/cma.j.cn112137-20210625-01436
[12]	孙振国, 杨红航, 李恒, 等. 腰椎定量CT对骨质疏松性胸腰椎骨折行椎体成形术的指导意义[J]. 中国骨伤, 2020,33(2): 111−115. doi: 10.12200/j.issn.1003-0034.2020.02.004 SUN Z G, YANG H H, LI H, et al. Guiding significance of lumbar quantitative computed tomography in percutaneous vertebroplasty for osteoporotic vertebral compression fractures[J]. China Journal of Orthopaedics and Traumatology, 2020, 33(2): 111−115. (in Chinese). doi: 10.12200/j.issn.1003-0034.2020.02.004
[13]	ZENG Q, LI N, WANG Q, et al. The prevalence of osteoporosis in china, a nationwide, multicenter dxa survey[J]. Journal of Bone and Mineral Research, 2019, 34(10): 1789−1797. DOI: 10.1002/jbmr.3757.
[14]	中华医学会骨质疏松和骨矿盐疾病分会. 中国骨质疏松症流行病学调查及"健康骨骼"专项行动结果发布[J]. 中华骨质疏松和骨矿盐疾病杂志, 2019,12(4): 317−318. doi: 10.3969/j.issn.1674-2591.2019.04.001
[15]	程晓光, 董剩勇, 王亮, 等. 应用双能X线骨密度仪调查中国人群骨密度水平和骨质疏松症患病率−多中心大样本体检人群调查[J]. 中华健康管理学杂志, 2019,13(1): 51−58. doi: 10.3760/cma.j.issn.1674?0815.2019.01.007 CHENG X G, DONG S Y, WANG L, et al. Prevalence of osteoporosis in China: A multicenter, large‐scale survey of a health checkup population[J]. Chinese Journal of Health Management, 2019, 13(1): 51−58. (in Chinese). doi: 10.3760/cma.j.issn.1674?0815.2019.01.007
[16]	马远征, 王以朋, 刘强, 等. 中国老年骨质疏松症诊疗指南(2018)[J]. 中国骨质疏松杂志, 2018,24(12): 1541−1567. doi: 10.3969/j.issn.1006-7108.2018.12.001 MA Y Z, WANG Y P, LIU Q, et al. 2018 China guideline for diagnosis and treatment of senile osteoporosis[J]. Chinese Journal of Osteoporosis, 2018, 24(12): 1541−1567. (in Chinese). doi: 10.3969/j.issn.1006-7108.2018.12.001
[17]	XU H, CHEN J X, GONG J, et al. Normal reference for bone density in healthy Chinese children[J]. Journal of Clinical Densitometry, 2007, 10(3): 266−275. DOI: 10.1016/j.jocd.2007.05.005.
[18]	KNAPP K M, BLAKE G M, SPECTOR T D, et al. Can the WHO definition of osteoporosis be applied to multi-site axial transmission quantitative ultrasound?[J]. Osteoporosis International, 2004, 15(5): 367−374. doi: 10.1007/s00198-003-1555-4
[19]	张智海, 刘忠厚, 石少辉, 等. 中国大陆地区以-2.5 SD为诊断的骨质疏松症发病率文献回顾性研究[J]. 中国骨质疏松杂志, 2015,21(1): 1−7,24. doi: 10.3969/j.issn.1006-7108.2015.01.001 ZHANG Z H, LIU Z H, SHI S H, et al. A retrospective literature study of osteoporosis incidence based on -2.5 SD criteria in mainland China[J]. Chinese Journal of Osteoporosis, 2015, 21(1): 1−7,24. (in Chinese). doi: 10.3969/j.issn.1006-7108.2015.01.001
[20]	XU X M, LI N, LI K, et al. Discordance in diagnosis of osteoporosis by quantitative computed tomography and dual-energy X-ray absorptiometry in Chinese elderly men[J]. Journal of Orthopaedic Translation, 2019, 18: 59−64. DOI: 10.1016/j.jot.2018.11.003.
[21]	ENGELKE K, ADAMS J E, ARMBRECHT G, et al. Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: The 2007 ISCD official positions[J]. Journal of Clinical Densitometry, 2008, 11(1): 123162. DOI: 10.1016/j.jocd.2007.12.010.
[22]	American College of Radiology. ACR-SPR-SSR practice parameter for the performance of musculoskeletal quantitative computed tomography (QCT) [EB/OL]. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/qct.pdf?la=en.
[23]	李凯, 陈捷, 赵林芬, 等. 中国人群定量CT(QCT)脊柱骨密度正常参考值的建立和骨质疏松症QCT诊断标准的验证[J]. 中国骨质疏松杂志, 2019,25(9): 1257−1262,1272. doi: 10.3969/j.issn.1006-7108.2019.09.011 LI K, CHEN J, ZHAO L F, et al. The establishment of QCT spinal vBMD reference database and the validation of the diagnosis criteria of osteoporosis with QCT for Chinese[J]. Chinese Journal of Osteoporosis, 2019, 25(9): 1257−1262,1272. (in Chinese). doi: 10.3969/j.issn.1006-7108.2019.09.011
[24]	王玲, 查晓娟, 杜霞, 等. 中国人群定量CT椎体骨密度正常参考数据库及与BMI、年龄的相关性: 基于中国健康定量CT大数据队列研究[J]. 中华骨质疏松和骨矿盐疾病杂志, 2022,15(1): 36−42. doi: 10.3969/j.issn.1674-2591.2022.01.007 WANG L, ZHA X J, DU X, et al. Quantitative CT spinal vBMD reference database for Chinese and the associations with BMI and age: Based on the China biobank study[J]. Chinese Journal of Osteoporosis and Bone Mineral Research, 2022, 15(1): 36−42. (in Chinese). doi: 10.3969/j.issn.1674-2591.2022.01.007
[25]	舒意, 杨沛, 廖紫祾, 等. 一站式低剂量扫描在胸部及腰椎QCT体检人群中的应用[J]. CT理论与应用研究, 2022, 31(2): 244-250. DOI: 10.15953/j.1004-4140.2022.31.02.12. SHU Y, YANG P, LIAO Z L, et al. To explore the low-dose CT and QCT “one-stop-shop” scan technology for physical examination crowd[J]. CT Theory and Applications, 2022 31(2): 244-250 DI: 10.15953/j. 1004-4140.2022. 31.02. 12. (in Chinese)
[26]	王勇朋, 阳琰, 何生生, 等. 低剂量胸部CT与QCT椎体骨密度测量一站式扫描可行性研究[J]. 放射学实践, 2018,33(11): 1194−1197. doi: 10.13609/j.cnki.1000-0313.2018.11.017 WANG Y P, YANG Y, HE S S, et al. Low-dose chest CT and QCT "one-stop-shop" scan technology: A feasibility study[J]. Radiologic Practice, 2018, 33(11): 1194−1197. (in Chinese). doi: 10.13609/j.cnki.1000-0313.2018.11.017
[27]	刘桐希, 李香凝, 曾庆, 等. 胸部低剂量CT筛查联合定量CT骨密度测量在健康体检中的应用[J]. 中华健康管理学杂志, 2018,12(3): 269−271. doi: 10.3760/cma.j.issn.1674-0815.2018.03.015 LIU T X, LI X N, ZENG Q, et al. Clinical use of low-dose computed tomography chest screening combined with quantitative computed tomography in the screening of osteoporosis in adults[J]. Chinese Journal of Health Management, 2018, 12(3): 269−271. (in Chinese). doi: 10.3760/cma.j.issn.1674-0815.2018.03.015
[28]	CHENG X, ZHAO K, ZHA X, et al. Opportunistic screening using low dose CT and the prevalence of osteoporosis in China: A nationwide, multicenter study[J]. Journal of Bone and Mineral Research, 2021, 36(3): 427−435. DOI: 10.1002/jbmr.4187.
[29]	姜文蓁, 张宇威, 崔效楠, 等. 胸部低剂量CT结合定量CT测量下段胸椎骨密度诊断骨质疏松[J]. 中国医学影像技术, 2022,38(5): 734−738. doi: 10.13929/j.issn.1003-3289.2022.05.024 JIANG W Z, ZHANG Y W, CUI X N, et al. Low-dose CT combined with quantitative CT measurement of bone mineral density of lower thoracic vertebri for diagnosing osteoporosis[J]. Chinese Journal of Medical Imaging Technology, 2022, 38(5): 734−738. (in Chinese). doi: 10.13929/j.issn.1003-3289.2022.05.024
[30]	滕剑, 彭飞, 张羽, 等. 定量CT测量胸椎骨密度诊断骨质疏松的初步研究[J]. 实用放射学杂志, 2022,38(4): 621−624. doi: 10.3969/j.issn.1002-1671.2022.04.026 TENG J, PENG F, ZHANG Y, et al. A preliminary study on the diagnosis of osteoporosis based on quantitative CT measurement of thoracic spine bone mineral density[J]. Journal of Practical Radiology, 2022, 38(4): 621−624. (in Chinese). doi: 10.3969/j.issn.1002-1671.2022.04.026
[31]	陈文清, 李建军, 陈峰, 等. 海南地区汉族健康成年人骨密度CT定量研究[J]. 海南医学, 2017,28(20): 3342−3345. doi: 10.3969/j.issn.1003-6350.2017.20.025 CHEN W Q, LI J J, CHEN F, et al. Quantitative CT study of bone mineral density for Han nationalities healthy adults in Hainan province[J]. Hainan Medical Journal, 2017, 28(20): 3342−3345. (in Chinese). doi: 10.3969/j.issn.1003-6350.2017.20.025
[32]	陈刘萍, 翟建, 冉利梅, 等. 中国成年男性人群脊柱定量CT骨密度参考值和地区差异[J]. 中华健康管理学杂志, 2022,16(9): 604−609. doi: 10.3760/cma.j.cn115624-20220516-00371 CHEN L P, ZHAI J, RAN L M, et al. Normal reference and regional variation of spinal bone mineral density under the quantitative CT in Chinese male population[J]. Chinese Journal of Health Management, 2022, 16(9): 604−609. (in Chinese). doi: 10.3760/cma.j.cn115624-20220516-00371
[33]	金鹰, 赵凯平, 瞿建, 等. 基于定量CT的中国健康成年女性腰椎骨密度正常参考值及地区差异[J]. 中华健康管理学杂志, 2022,16(9): 610−615. doi: 10.3760/cma.j.cn115624-20220321-00186 JIN Y, ZHAO K P, QU J, et al. Reference value of lumbar spine bone mineral density and regional differences based on quantitative CT examination in healthy adult female in China[J]. Chinese Journal of Health Management, 2022, 16(9): 610−615. (in Chinese). doi: 10.3760/cma.j.cn115624-20220321-00186