跟骨定量超声测量筛查体检绝经期妇女骨质疏松症的临床价值分析
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摘要
目的分析并评价跟骨定量超声测量(QUS)筛查体检绝经期妇女骨质疏松症的临床价值。方法采用采用前瞻性随机单盲对照研究法,选择2017年1月至2018年6月沧州中西医结合医院体检中心收入的450例健康体检的绝经期妇女作为研究对象,分别给予双能X线吸收仪(DXA)检测和QUS检测,以DXA检测结果为金标准,评价QUS筛查绝经期妇女骨质疏松症的临床价值,同时观察不同年龄段(≤59岁226例、60～69岁142例、≥70岁82例)妇女的骨密度变化情况。结果 DXA诊断骨质疏松症共81例,QUS诊断骨质疏松症共69例,以DXA检测结果为金标准,QUS诊断正确67例,其诊断正确率为97. 1%(67/69)。同时,QUS诊断骨质疏松症的特异度、灵敏度、阳性预测值、阴性预测值分别为99. 5%、82. 7%、97. 1%、96. 3%;≤59岁组、60～69岁组、≥70岁组的刚度(SI)、超声振幅衰减(BUA)、超声传导速度(SOS)参数比较差异均具有统计学意义(P <0. 05);≤59岁组、60～69岁组、≥70岁组患骨质疏松症的比率分别为9. 3%、15. 5%、31. 7%,差异具有统计学意义(Z=21. 365,P <0. 01)。结论 QUS筛查绝经期妇女骨质疏松症的诊断正确率较高,诊断特异度及灵敏度均较好,具有较高的临床应用价值;随着年龄的增加,绝经期妇女患骨质疏松症的概率也会随之增大。
Objective To analyze and evaluate the clinical value of quantitative calcaneal ultrasound( QUS) in screening osteoporosis in postmenopausal women in community. Methods A prospective randomized,single-blind,controlled study was conducted to select 450 healthy menopausal women from the Physical Examination Center of Zhangzhou Chinese Traditional Medicine combined Western Medicine Hospital during January 2017 to June 2018 as subjects.( DXA) detection and QUS testing,by using results of DXA test as the gold standard,evaluating the clinical value of QUS screening for osteoporosis in menopausal women,and observing different age groups( 226 cases of ≤59 years old,142 cases of60 ～ 69 years old,≥70 years old 82 cases) changes in bone mineral density in women. Results DXA diagnosed 81 cases of osteoporosis,and QUS diagnosed osteoporosis in 69 cases. The DXA test results were the gold standard,and QUS diagnosis was correct in 67 cases. The diagnostic accuracy was 97. 1%( 67/69). At the same time,the specificity,sensitivity,positive predictive value and negative predictive value of QUS diagnosis of osteoporosis were 99. 5%,82. 7%,97. 1% and 96. 3% in ≤59 years old,60 ～ 69 years old and ≥70 years old groups The difference in stiffness( SI),ultrasonic amplitude attenuation( BUA),and ultrasound conduction velocity( SOS) parameters were statistically significant( P <0. 05). The percentages of quality loosening in ≤59 years old,60 ～ 69 years old and ≥70 years old group suffered bone loosening were 9. 3%,15. 5%,and 31. 7%,respectively,and the difference was statistically significant( Z = 21. 365,P < 0. 01). Conclusion QUS screening for menopausal women with osteoporosis has a high diagnostic accuracy rate,good diagnostic specificity and sensitivity,and it has a high clinical value; with the increase of age,the probability of osteoporosis in menopausal women is increased.
Objective To analyze and evaluate the clinical value of quantitative calcaneal ultrasound( QUS) in screening osteoporosis in postmenopausal women in community. Methods A prospective randomized,single-blind,controlled study was conducted to select 450 healthy menopausal women from the Physical Examination Center of Zhangzhou Chinese Traditional Medicine combined Western Medicine Hospital during January 2017 to June 2018 as subjects.( DXA) detection and QUS testing,by using results of DXA test as the gold standard,evaluating the clinical value of QUS screening for osteoporosis in menopausal women,and observing different age groups( 226 cases of ≤59 years old,142 cases of60 ～ 69 years old,≥70 years old 82 cases) changes in bone mineral density in women. Results DXA diagnosed 81 cases of osteoporosis,and QUS diagnosed osteoporosis in 69 cases. The DXA test results were the gold standard,and QUS diagnosis was correct in 67 cases. The diagnostic accuracy was 97. 1%( 67/69). At the same time,the specificity,sensitivity,positive predictive value and negative predictive value of QUS diagnosis of osteoporosis were 99. 5%,82. 7%,97. 1% and 96. 3% in ≤59 years old,60 ～ 69 years old and ≥70 years old groups The difference in stiffness( SI),ultrasonic amplitude attenuation( BUA),and ultrasound conduction velocity( SOS) parameters were statistically significant( P <0. 05). The percentages of quality loosening in ≤59 years old,60 ～ 69 years old and ≥70 years old group suffered bone loosening were 9. 3%,15. 5%,and 31. 7%,respectively,and the difference was statistically significant( Z = 21. 365,P < 0. 01). Conclusion QUS screening for menopausal women with osteoporosis has a high diagnostic accuracy rate,good diagnostic specificity and sensitivity,and it has a high clinical value; with the increase of age,the probability of osteoporosis in menopausal women is increased.
引文
[1]张智海,刘忠厚,李娜,等.中国人骨质疏松症诊断标准专家共识(第三稿·2014版)[J].中国骨质疏松杂志,2014,20(9):1007-1010.
[2]梁永南,李丽,陈桐生,等.双能X线吸收法测量骨密度的质量控制[J].医疗装备,2016,29(9):54-55.
[3]陆花菊.定量超声与定量CT骨密度测量值相关性研究[J].养生保健指南,2016,43:216.
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[5]张岩,邵进,刘树义,等.FRAX及OSTA指数在绝经后骨质疏松风险评估中的作用[J].临床和实验医学杂志,2017,16(3):243-246.
[6]姜晨吉,沈旭慧,林梅.围绝经期妇女骨质疏松症的预防与保健指导[J].科技资讯,2016,14(19):159-160.
[7]马信龙.认识、重视骨质疏松症,提高骨质疏松性骨折的诊疗水平[J].中华骨科杂志,2014,34(1):1-5.
[8]何烨棋,姚金兰,林梅.围绝经期妇女骨质疏松症的病因分析及防治[J].科技资讯,2016,14(19)171-172.
[9]Casciaro S,Conversano F,Pisani P,et al.New perspectives in echographic diagnosis of osteoporosis on hip and spine[J].Clin Cases Miner Bone Metab,2015,12(2):142-150.
[10]王丹丹,伍西羽,廖二元,等.女性年龄相关的骨形成指标变化与骨密度减少的关系[J].中华内分泌代谢杂志,2013,29(4):297-301.
[11]Bossy E,Talmant M,Peyrin F,et al.An in vitro study of the ultrasonic axial transmission technique at the radius:1-MHz velocity measurements are sensitive to both mineralization and intracortical porosity[J].J Bone Mineral Res,2010,19(9):1548-1556.
[12]胡一顺,李潜,林寰东,等.跟骨定量超声骨强度在骨质疏松筛查和诊断中的价值[J].中华内科杂志,2015,54(1):27-30.
[13]王昱,周炜,郝燕捷,等.跟骨定量超声在筛查结缔组织病患者合并骨质疏松中的应用[J].北京大学学报(医学版),2013,45(5):766-769.
[2]梁永南,李丽,陈桐生,等.双能X线吸收法测量骨密度的质量控制[J].医疗装备,2016,29(9):54-55.
[3]陆花菊.定量超声与定量CT骨密度测量值相关性研究[J].养生保健指南,2016,43:216.
[4]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治指南(2011年)[J].中华骨质疏松和骨矿盐疾病杂志,2011,4(1):2-17.
[5]张岩,邵进,刘树义,等.FRAX及OSTA指数在绝经后骨质疏松风险评估中的作用[J].临床和实验医学杂志,2017,16(3):243-246.
[6]姜晨吉,沈旭慧,林梅.围绝经期妇女骨质疏松症的预防与保健指导[J].科技资讯,2016,14(19):159-160.
[7]马信龙.认识、重视骨质疏松症,提高骨质疏松性骨折的诊疗水平[J].中华骨科杂志,2014,34(1):1-5.
[8]何烨棋,姚金兰,林梅.围绝经期妇女骨质疏松症的病因分析及防治[J].科技资讯,2016,14(19)171-172.
[9]Casciaro S,Conversano F,Pisani P,et al.New perspectives in echographic diagnosis of osteoporosis on hip and spine[J].Clin Cases Miner Bone Metab,2015,12(2):142-150.
[10]王丹丹,伍西羽,廖二元,等.女性年龄相关的骨形成指标变化与骨密度减少的关系[J].中华内分泌代谢杂志,2013,29(4):297-301.
[11]Bossy E,Talmant M,Peyrin F,et al.An in vitro study of the ultrasonic axial transmission technique at the radius:1-MHz velocity measurements are sensitive to both mineralization and intracortical porosity[J].J Bone Mineral Res,2010,19(9):1548-1556.
[12]胡一顺,李潜,林寰东,等.跟骨定量超声骨强度在骨质疏松筛查和诊断中的价值[J].中华内科杂志,2015,54(1):27-30.
[13]王昱,周炜,郝燕捷,等.跟骨定量超声在筛查结缔组织病患者合并骨质疏松中的应用[J].北京大学学报(医学版),2013,45(5):766-769.