人体脂肪含量及分布DEXA测量的可行性研究
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摘要
目的 研究肥胖症患者和正常人的体内脂肪含量及脂肪分布规律，探寻双能X线吸收测量法的肥胖症定量诊断指标，增加肥胖症影像学诊断客观依据。
材料和方法 动物标本实验，以两组猪肉标本为实验对象，分为标本1和标本2，两个猪肉标本由容易进行切割分离的脂肪组织和非脂肪组织组成。标本1重量2511克，标本2重量为2533克。肥胖症患者组135人，为2002年3月至2003年12月期间在广西医科大学第一附属医院就诊患者，BMI计算均诊断为肥胖症。男性69人, 平均年龄为 63.54±15.30岁,平均身高为 167.00±5.47ｃｍ,平均体重75.88±7.84kg；女性66人,平均年龄为 58.35±9.51岁,平均身高为 155.33±5.93cm,平均体重66.05±9.04kg。对照组75人，为门诊健康体检人群，BMI计算均为正常的体重指数。包括男性46人，平均年龄58.24±19.5岁，平均身高为 167.65±5.71cm,平均体重63.11±6.64kg；女性29人，平均年龄57.62±11.68岁，平均身高为156.64±6.76cm,平均体重52.18±6.97kg。DEXA装置为美国 GE 公司（Lunar）生产的PLODIGY型双能Ｘ线骨密度测定仪。动物标本的DEXA测定，是分别把标本摆放在检查床上，应用标准（standard）模式,扫描架从上头向下头进行扫描，扫描结束即用手术刀对标本进行仔细的切割和分离，把脂肪组织和非脂肪组织彻底分开，用电
子秤来分别测量, 每份均重复测量三次取其平均值。人体测量：采用医用身高体重测量仪进行常规测量身高(height)、体重(weight)，同时计算BMI=体重(kg)/身高2(m2)。肥胖症组及对照组分别进行DEXA扫描，被检测者平卧于检查床上，用DEXA标准（standard）模式,扫描架从头侧向足侧运动并进行扫描。扫描时间大约５min测定结束。记录全身及局部包括上肢、下肢 、躯干和全身的脂肪含量、瘦体质及骨密度、骨质含量等参数。研究项目：1、统计比较动物标本的DEXA及电子秤测量结果；统计比较人体重量的DEXA及磅秤测定结果，以检验DEXA对脂肪与非脂肪成分的检测能力；2、检测不同年龄、性别的正常人体内脂肪与非脂肪含量及分布比例的DEXA数据；3、检测不同年龄、性别的肥胖症患者体内脂肪与非脂肪含量及分布比例的DEXA数据,探讨肥胖症DEXA的诊断指标；4、研究对照组与肥胖症患者组脂肪含量与分布和骨矿含量的相关性。
结果 1、DEXA法与电子秤对猪肉标本1的总量测量结果分别为2520克和2511克，差异率0.36%; 标本1所含脂肪测量结果分别为1220克和1166克，差异率4.4%；标本1所含非脂肪组织测量结果分别为1294克和1345克，差异率为3.8%；两方法对猪肉标本2的总量测量结果分别为2547克和2533克，差异率0.55%; 标本2所含脂肪测量结果分别为914克和871克，差异率4.7%;标本2所含非脂肪组织测量结果分别为1626克和1662克，差异率2.2%。2、全部210例研究对象都用DEXA与磅秤分别测量体重, 结果分别为66.71±10.97kg和66.62±10.91kg，结果进行t检验，p=0.93, p>0.05, 两者无显著性差异。3、对照组女性的上肢、下肢、躯干及全身的脂肪含量分别平均为29.14±5.35%、27.59±3.93%、30.6±6.64%、25.62±3.97%，男性分别平均为
23.56±8.25%、22.21±5.76%、22.47±8.86%、21.7±5.0%。女性全身骨密度平均为1.054±0.092(g/cm2)，男性平均为1.101±0.103(g/cm2)。4、肥胖组男性上肢、下肢、躯干及全身的脂肪含量分别平均为31.03±6.53%、27.67±4.43、29.38±6.68%、27.24±4.87%,女性的分别平均为42.46±5.89%、38.85±6.1%、41.25±5.38%、38.35±6.43%。男性全身骨密度平均为1.139±0.107(g/cm2)；女性平均为1.064±0.097(g/cm2)。肥胖男性的全身脂肪含量频数表百分位数95%可信区间的下限值 P5=23，肥胖女性P5=29。DEXA对肥胖男性测定的敏感度=87.88%,特异度=77.55%,准确度=83.48%；对肥胖女性测定的敏感度=92.54%,特异度=85.72%,准确度=90.53%。6、在每个年龄段的男、女性，肥胖组的全身脂肪含量和骨密度都大于对照组，无论肥胖组或对照组，女性的脂肪含量都高于男性；男性的全身骨密度和体重都高于女性。男、女性的全身脂肪含量在50~59岁年龄段最高，而骨密度在大于70岁年龄段都下降明显。
结论 1．DEXA法对组织含量的测量结果与精密仪器电子秤的测量结果一致。2．DEXA不仅对人体内脂肪含量进行定量评价，同时可对人体内包括上肢、下肢和躯干部位的脂肪分布进行客观评价。3．本研究初步结果显示，人体内全身的脂肪含量判断肥胖切点男性为23%，女性为29%。4．女性的上肢 、下肢 、躯干及全身的脂肪含量均高于男性，以躯干部位比较明显，提示女性躯干型肥胖相关的疾病危险性可能较男性增加。5．肥胖者的骨密度相对高于非肥胖者，提示体内脂肪与骨矿物质含量存在一定的相关性。
Objective: to study the regularity of the body fat composition and distribution of Chinese obesity and healthy persons by DEXA in an attempt to explore the diagnosis index of the obesity determined by DEXA and provide an approach for the obesity diagnosis on the basis of medical imaging studies.
Material & Method: pork was the subject of the animal experiment，dividing into Sample 1 and Sample 2, which were easily incised into the fat part and the lean part (the weight of S1 was 2531 grams, S2 2533 grams). The subject of the study was divided into two groups, the obesity group and the control group. There were 135 cases in the obesity group diagnosed by their BMI in the First Affiliate Hospital of Guangxi Medical University during the period of March 2002 to December 2003.Among them, there were 69 male patients, with average age of 63.54±15.30, height of 167.00±5.47cm, and weight of 75.88±7.84kg , while the female were 66 with average age of 58.35±9.51, height of 155.33±5.93 cm, weight of 66.05±9.04kg. There were 75 persons in the control group from the crowd of healthy outpatient (normal BMI) who came to have a routine check-up in the First Affiliate Hospital of Guangxi Medical University. Among them, there were 46 male persons, with average age of 58.24±19.5，height of 167.65±5.71cm,
weight of 63.11±6.64kg, while the female were 29 with average age of 57.62±11.68, height of 156.64±6.76 cm, weight of 52.18±6.97kg.. The DEXA device was “ Lunar PLODIGY” bone densitometry. Put the pork sample on the treatment table to have a DEXA scan, with scanner over the upward to the downward by standard mode. After the scanning, the sample were incised and separated into fat part and lean one by a surgical knife, of which were weighed three times respectively by an electronic scale and got the average weight of each. Used the medical body height and weight measuring instrument to carry height and weight on the routine measurement, simultaneously calculated the BMI= body weight (kg)/the height2 (m2). Make the subject lie flat on the treatment table and make a DEXA scan in a standard mode, while the scanner moved over the head side to the leg side within five minutes, recording the total and local parameters (the fat composition, the lean, the BMD and BMC of the arm, leg, trunk and total body). The present study included the following items: ①to examine the diagnosing ability by DEXA between the fat and non-fat composition; ②to obtain some DEXA statistic data of the body fat and nonfat composition and distribution in the healthy subject population of different age and sex; ③to obtain some DEXA statistic data of the body fat and nonfat composition and distribution in the patient subject population of different age and sex in an attempt to explore the diagnosing index of obesity determined by DEXA; ④to examine the correlation between fat composition and distribution and the bone mineral content in the control group and obesity group.
Result: 1. As the results of the animal sample experiment show, the total quantity of the sample 1 measured by DEXA and the electronic scale respectively are 2520 gram and 2511 grams, and the difference rate are 0.36%; the fat quantity of sample 1 respectively are 1220 grams and 1166 grams, and the difference rate is 4.4%; the lean quantity of sample 1 respectively are 1294 grams and 1345 gram, and the difference rate is 3.8%; two methods to sample 2 the total quantity measurement respectively are 2547 gram and 2533 grams, and the difference rate are 0.55%; the fat quantity of sample 2 respectively are 914 grams and 871 grams, and the difference rate is 4.7%; the lean quantity of sample 1 respectively are 1626 grams and 1662 gram, and the difference rate is 2.2%. 2. All 210 subjects were weighed both by DEXA and the platform scale, with a result of 66.71±10.97kg and 66.62±10.91kg respectively. As the t-test shows, there is no significant difference between the two methods (p=0.93, p>0.05). 3. The fat content of the arm, leg, trunk and total body of female in the
材料和方法 动物标本实验，以两组猪肉标本为实验对象，分为标本1和标本2，两个猪肉标本由容易进行切割分离的脂肪组织和非脂肪组织组成。标本1重量2511克，标本2重量为2533克。肥胖症患者组135人，为2002年3月至2003年12月期间在广西医科大学第一附属医院就诊患者，BMI计算均诊断为肥胖症。男性69人, 平均年龄为 63.54±15.30岁,平均身高为 167.00±5.47ｃｍ,平均体重75.88±7.84kg；女性66人,平均年龄为 58.35±9.51岁,平均身高为 155.33±5.93cm,平均体重66.05±9.04kg。对照组75人，为门诊健康体检人群，BMI计算均为正常的体重指数。包括男性46人，平均年龄58.24±19.5岁，平均身高为 167.65±5.71cm,平均体重63.11±6.64kg；女性29人，平均年龄57.62±11.68岁，平均身高为156.64±6.76cm,平均体重52.18±6.97kg。DEXA装置为美国 GE 公司（Lunar）生产的PLODIGY型双能Ｘ线骨密度测定仪。动物标本的DEXA测定，是分别把标本摆放在检查床上，应用标准（standard）模式,扫描架从上头向下头进行扫描，扫描结束即用手术刀对标本进行仔细的切割和分离，把脂肪组织和非脂肪组织彻底分开，用电
子秤来分别测量, 每份均重复测量三次取其平均值。人体测量：采用医用身高体重测量仪进行常规测量身高(height)、体重(weight)，同时计算BMI=体重(kg)/身高2(m2)。肥胖症组及对照组分别进行DEXA扫描，被检测者平卧于检查床上，用DEXA标准（standard）模式,扫描架从头侧向足侧运动并进行扫描。扫描时间大约５min测定结束。记录全身及局部包括上肢、下肢 、躯干和全身的脂肪含量、瘦体质及骨密度、骨质含量等参数。研究项目：1、统计比较动物标本的DEXA及电子秤测量结果；统计比较人体重量的DEXA及磅秤测定结果，以检验DEXA对脂肪与非脂肪成分的检测能力；2、检测不同年龄、性别的正常人体内脂肪与非脂肪含量及分布比例的DEXA数据；3、检测不同年龄、性别的肥胖症患者体内脂肪与非脂肪含量及分布比例的DEXA数据,探讨肥胖症DEXA的诊断指标；4、研究对照组与肥胖症患者组脂肪含量与分布和骨矿含量的相关性。
结果 1、DEXA法与电子秤对猪肉标本1的总量测量结果分别为2520克和2511克，差异率0.36%; 标本1所含脂肪测量结果分别为1220克和1166克，差异率4.4%；标本1所含非脂肪组织测量结果分别为1294克和1345克，差异率为3.8%；两方法对猪肉标本2的总量测量结果分别为2547克和2533克，差异率0.55%; 标本2所含脂肪测量结果分别为914克和871克，差异率4.7%;标本2所含非脂肪组织测量结果分别为1626克和1662克，差异率2.2%。2、全部210例研究对象都用DEXA与磅秤分别测量体重, 结果分别为66.71±10.97kg和66.62±10.91kg，结果进行t检验，p=0.93, p>0.05, 两者无显著性差异。3、对照组女性的上肢、下肢、躯干及全身的脂肪含量分别平均为29.14±5.35%、27.59±3.93%、30.6±6.64%、25.62±3.97%，男性分别平均为
23.56±8.25%、22.21±5.76%、22.47±8.86%、21.7±5.0%。女性全身骨密度平均为1.054±0.092(g/cm2)，男性平均为1.101±0.103(g/cm2)。4、肥胖组男性上肢、下肢、躯干及全身的脂肪含量分别平均为31.03±6.53%、27.67±4.43、29.38±6.68%、27.24±4.87%,女性的分别平均为42.46±5.89%、38.85±6.1%、41.25±5.38%、38.35±6.43%。男性全身骨密度平均为1.139±0.107(g/cm2)；女性平均为1.064±0.097(g/cm2)。肥胖男性的全身脂肪含量频数表百分位数95%可信区间的下限值 P5=23，肥胖女性P5=29。DEXA对肥胖男性测定的敏感度=87.88%,特异度=77.55%,准确度=83.48%；对肥胖女性测定的敏感度=92.54%,特异度=85.72%,准确度=90.53%。6、在每个年龄段的男、女性，肥胖组的全身脂肪含量和骨密度都大于对照组，无论肥胖组或对照组，女性的脂肪含量都高于男性；男性的全身骨密度和体重都高于女性。男、女性的全身脂肪含量在50~59岁年龄段最高，而骨密度在大于70岁年龄段都下降明显。
结论 1．DEXA法对组织含量的测量结果与精密仪器电子秤的测量结果一致。2．DEXA不仅对人体内脂肪含量进行定量评价，同时可对人体内包括上肢、下肢和躯干部位的脂肪分布进行客观评价。3．本研究初步结果显示，人体内全身的脂肪含量判断肥胖切点男性为23%，女性为29%。4．女性的上肢 、下肢 、躯干及全身的脂肪含量均高于男性，以躯干部位比较明显，提示女性躯干型肥胖相关的疾病危险性可能较男性增加。5．肥胖者的骨密度相对高于非肥胖者，提示体内脂肪与骨矿物质含量存在一定的相关性。
Objective: to study the regularity of the body fat composition and distribution of Chinese obesity and healthy persons by DEXA in an attempt to explore the diagnosis index of the obesity determined by DEXA and provide an approach for the obesity diagnosis on the basis of medical imaging studies.
Material & Method: pork was the subject of the animal experiment，dividing into Sample 1 and Sample 2, which were easily incised into the fat part and the lean part (the weight of S1 was 2531 grams, S2 2533 grams). The subject of the study was divided into two groups, the obesity group and the control group. There were 135 cases in the obesity group diagnosed by their BMI in the First Affiliate Hospital of Guangxi Medical University during the period of March 2002 to December 2003.Among them, there were 69 male patients, with average age of 63.54±15.30, height of 167.00±5.47cm, and weight of 75.88±7.84kg , while the female were 66 with average age of 58.35±9.51, height of 155.33±5.93 cm, weight of 66.05±9.04kg. There were 75 persons in the control group from the crowd of healthy outpatient (normal BMI) who came to have a routine check-up in the First Affiliate Hospital of Guangxi Medical University. Among them, there were 46 male persons, with average age of 58.24±19.5，height of 167.65±5.71cm,
weight of 63.11±6.64kg, while the female were 29 with average age of 57.62±11.68, height of 156.64±6.76 cm, weight of 52.18±6.97kg.. The DEXA device was “ Lunar PLODIGY” bone densitometry. Put the pork sample on the treatment table to have a DEXA scan, with scanner over the upward to the downward by standard mode. After the scanning, the sample were incised and separated into fat part and lean one by a surgical knife, of which were weighed three times respectively by an electronic scale and got the average weight of each. Used the medical body height and weight measuring instrument to carry height and weight on the routine measurement, simultaneously calculated the BMI= body weight (kg)/the height2 (m2). Make the subject lie flat on the treatment table and make a DEXA scan in a standard mode, while the scanner moved over the head side to the leg side within five minutes, recording the total and local parameters (the fat composition, the lean, the BMD and BMC of the arm, leg, trunk and total body). The present study included the following items: ①to examine the diagnosing ability by DEXA between the fat and non-fat composition; ②to obtain some DEXA statistic data of the body fat and nonfat composition and distribution in the healthy subject population of different age and sex; ③to obtain some DEXA statistic data of the body fat and nonfat composition and distribution in the patient subject population of different age and sex in an attempt to explore the diagnosing index of obesity determined by DEXA; ④to examine the correlation between fat composition and distribution and the bone mineral content in the control group and obesity group.
Result: 1. As the results of the animal sample experiment show, the total quantity of the sample 1 measured by DEXA and the electronic scale respectively are 2520 gram and 2511 grams, and the difference rate are 0.36%; the fat quantity of sample 1 respectively are 1220 grams and 1166 grams, and the difference rate is 4.4%; the lean quantity of sample 1 respectively are 1294 grams and 1345 gram, and the difference rate is 3.8%; two methods to sample 2 the total quantity measurement respectively are 2547 gram and 2533 grams, and the difference rate are 0.55%; the fat quantity of sample 2 respectively are 914 grams and 871 grams, and the difference rate is 4.7%; the lean quantity of sample 1 respectively are 1626 grams and 1662 gram, and the difference rate is 2.2%. 2. All 210 subjects were weighed both by DEXA and the platform scale, with a result of 66.71±10.97kg and 66.62±10.91kg respectively. As the t-test shows, there is no significant difference between the two methods (p=0.93, p>0.05). 3. The fat content of the arm, leg, trunk and total body of female in the
引文
1 王克安，李天麟，向红丁，等. 中国成年人肥胖的流行特点研究，超重和肥胖的现患病率调查. 中华流行病学杂志 2001.22(2): 129-132
2 黄淑仪，朱达泉，陈凤娟等. 身体脂肪分布与血脂、血压的相关性研究. 数理医药学杂志，1999，12（1）：30—32.
3 傅祖植.开展与肥胖症相关课题的研究是新世纪的迫切任务.中华内分泌杂志，2000；16（2）：65—66
4 张燕妮.B超评定人体脂肪分布类型及其临床价值的研究.中国超声医学杂志，1991；7（4）：238—239
5 Mazess RB, Peppler WW, Chestut CH III, et al. Total body bone mineral and lean body mass by dual-photon absorptiometry, II: Comparison with total body calcium by neutron activisceral adipose tissueion analysis. Calcif Tiss Intl 1981, 33 : 361-363
6 Mazess RB, Peppler WW, Gibbons M Total body composition by dual-photon(153Gd) absorptiometry. Am J Clin Nutr 1984, 40: 834-839
7 Mazess RB,Trempe JA, Bisek JP, et al. Calibration of dual-energy x-ray absorptiometry for bone density. J Bn Miner Res 1991, 6: 799-806
姜梅; 黄玉春; 华天懿;等. 肥胖男童骨矿物质含量及瘦体重的研究. 中国儿童保健杂志 2001.06.10; 9(3): 165-167
The Asia-Pacific perspective: Redefining obesity and its treatment [M ] . Hong Kong: WHO. IOTF. IASO, 2000.
王育才,杨景林,李清亚,等. 利用生物电阻抗测量人体脂肪的研究. 营养学
报. 1994,03,03:16(1):78-82
11 Yoshizumi ,Nakamura, Yamane, et al. Abdominal Fat: Standardized Technique for Measurement at CT. Radiology 1999;211: 283-286
12 张荣欣,薛长勇,郑子新等.成人BMI与体脂含量和脂肪分布的关系.中国儿童保健杂志,2001,9(3):144-147
13 王战建. 肥胖症的诊断进展. 临床荟萃，2002，17（2）：123-124.
14 Mazess RB，Burden HS，Bisek JP,et al. Dual-energy X-ray absorptiometry for total body and regional bone-mineral and soft tissue composition. Am J Clin Nutr 1990,51:1106-1112.
15 S.R.Daniels, T.R.Kimball，P.Khoury et al. correlates of the hemodynamic determinants of blood pressure. Hypertension,1996,28:37-41.
16 R.H.Nord and R.k.Payne. Body composition by dual-energy X-ray absorptionmetry—review of the technology. Asia Pacific J Clin Nutr, 1996,112: 232-237.
17 Wendy M.kohrt. Dual-Energy X-Ray Absorptiomtry: Research Issues and Equipment. Emerging Technologies for Nutrition Research, 1997, 151-167. Washington, D.C. National Academy Press.
18 明伟; 余卫; 徐苓;等. 正常人全身骨量及人体组成变化: 附292例DXA测量分析. 中国医学科学院学报 2003.02.28; 25(1): 66-69
19 H. kanai, K.Tokunaga, S.Fujioka et al. decrease in intra-abdominal visceral fat may reduce blood pressure in obese hypertension women. Hypertension, 1996:27:125-129.
20 Einsier RL, Hunter GR, Gower BA, et al. Body fat distribution in white and black women :different patterns of intra-abdominal and subcutaneous abdominal adipose tissue utilization with weight loss. Am J Clin Nutr,2001, 74(5):631-636.
21 Tothhill P, et al. comparisons between a pencil beam and fan beam dual energy X-ray obsorptiometers used for measuring total body and soft tissue. Br J Radiol,2001;74:166—176
22 陆一帆,张勇.身体成分及脂肪组织分布研究的方法进展.天津体育学院学报,1999,14(1):10-11
23 张荣欣, 薛长勇,王伟琴,等.988名汉族成年人人体测量研究. 营养学报.2000,22(2):179-182.
24 李慧,黄坚,常小芳,等.深圳市学龄儿童BMI肥胖标准参考值的建立.现代预防医学,2001,28(2):138-140.
25 刘继洪，杨延斌，曹海伟等．成年人骨密度、骨量、体重、年龄、身高、脂肪含量相互关系的研究.实用医学杂志，2002,18(2):146-147
26 桑士标,王栋梁,吴翼伟.应用双能X线骨密度仪测定131名健康妇女骨密度变化.核技术,2002,25(5):383-386
27 杨蕊敏.DEXA测定老年人骨密度186例报告.实用老年医学, 1996,10(5):209-210
28 何玉香，潘信群，孟昭亨.双能X线吸收法测量252例正常人BMD结果分析.中国骨质疏松杂志,1995,1(2):159-162
29 Albala C, Yanez M , Devoto E, et al. Obesity as a protective factor for
postmenopausal ostoporosis . Int J Obes Metab Disord, 1996,20:1027-1032.
30 Pichard, C, Kyle UG, Janssens JP, et al. Body composition by X-ray absorptiometry and bioelectrical impedance in chronic respiratory insufficiency patients .1997 ,13:952-958.
31 Madden AM, Morgan My. The potential role of Dual-energy X-ray absorptiometry in the assessment of body composition in cirrhotic patients. Nutrition ,1997, 13:40-45.
32 Pichard C, kyle UG, Slos man DO. Fat-free mass in chronic illness: Comparison of bioelectrical impedance and Dual-energy X-ray absorptiometry in 480 chronically ill and healthy subjects. Nutrition, 1999, 15 :668-676.
2 黄淑仪，朱达泉，陈凤娟等. 身体脂肪分布与血脂、血压的相关性研究. 数理医药学杂志，1999，12（1）：30—32.
3 傅祖植.开展与肥胖症相关课题的研究是新世纪的迫切任务.中华内分泌杂志，2000；16（2）：65—66
4 张燕妮.B超评定人体脂肪分布类型及其临床价值的研究.中国超声医学杂志，1991；7（4）：238—239
5 Mazess RB, Peppler WW, Chestut CH III, et al. Total body bone mineral and lean body mass by dual-photon absorptiometry, II: Comparison with total body calcium by neutron activisceral adipose tissueion analysis. Calcif Tiss Intl 1981, 33 : 361-363
6 Mazess RB, Peppler WW, Gibbons M Total body composition by dual-photon(153Gd) absorptiometry. Am J Clin Nutr 1984, 40: 834-839
7 Mazess RB,Trempe JA, Bisek JP, et al. Calibration of dual-energy x-ray absorptiometry for bone density. J Bn Miner Res 1991, 6: 799-806
姜梅; 黄玉春; 华天懿;等. 肥胖男童骨矿物质含量及瘦体重的研究. 中国儿童保健杂志 2001.06.10; 9(3): 165-167
The Asia-Pacific perspective: Redefining obesity and its treatment [M ] . Hong Kong: WHO. IOTF. IASO, 2000.
王育才,杨景林,李清亚,等. 利用生物电阻抗测量人体脂肪的研究. 营养学
报. 1994,03,03:16(1):78-82
11 Yoshizumi ,Nakamura, Yamane, et al. Abdominal Fat: Standardized Technique for Measurement at CT. Radiology 1999;211: 283-286
12 张荣欣,薛长勇,郑子新等.成人BMI与体脂含量和脂肪分布的关系.中国儿童保健杂志,2001,9(3):144-147
13 王战建. 肥胖症的诊断进展. 临床荟萃，2002，17（2）：123-124.
14 Mazess RB，Burden HS，Bisek JP,et al. Dual-energy X-ray absorptiometry for total body and regional bone-mineral and soft tissue composition. Am J Clin Nutr 1990,51:1106-1112.
15 S.R.Daniels, T.R.Kimball，P.Khoury et al. correlates of the hemodynamic determinants of blood pressure. Hypertension,1996,28:37-41.
16 R.H.Nord and R.k.Payne. Body composition by dual-energy X-ray absorptionmetry—review of the technology. Asia Pacific J Clin Nutr, 1996,112: 232-237.
17 Wendy M.kohrt. Dual-Energy X-Ray Absorptiomtry: Research Issues and Equipment. Emerging Technologies for Nutrition Research, 1997, 151-167. Washington, D.C. National Academy Press.
18 明伟; 余卫; 徐苓;等. 正常人全身骨量及人体组成变化: 附292例DXA测量分析. 中国医学科学院学报 2003.02.28; 25(1): 66-69
19 H. kanai, K.Tokunaga, S.Fujioka et al. decrease in intra-abdominal visceral fat may reduce blood pressure in obese hypertension women. Hypertension, 1996:27:125-129.
20 Einsier RL, Hunter GR, Gower BA, et al. Body fat distribution in white and black women :different patterns of intra-abdominal and subcutaneous abdominal adipose tissue utilization with weight loss. Am J Clin Nutr,2001, 74(5):631-636.
21 Tothhill P, et al. comparisons between a pencil beam and fan beam dual energy X-ray obsorptiometers used for measuring total body and soft tissue. Br J Radiol,2001;74:166—176
22 陆一帆,张勇.身体成分及脂肪组织分布研究的方法进展.天津体育学院学报,1999,14(1):10-11
23 张荣欣, 薛长勇,王伟琴,等.988名汉族成年人人体测量研究. 营养学报.2000,22(2):179-182.
24 李慧,黄坚,常小芳,等.深圳市学龄儿童BMI肥胖标准参考值的建立.现代预防医学,2001,28(2):138-140.
25 刘继洪，杨延斌，曹海伟等．成年人骨密度、骨量、体重、年龄、身高、脂肪含量相互关系的研究.实用医学杂志，2002,18(2):146-147
26 桑士标,王栋梁,吴翼伟.应用双能X线骨密度仪测定131名健康妇女骨密度变化.核技术,2002,25(5):383-386
27 杨蕊敏.DEXA测定老年人骨密度186例报告.实用老年医学, 1996,10(5):209-210
28 何玉香，潘信群，孟昭亨.双能X线吸收法测量252例正常人BMD结果分析.中国骨质疏松杂志,1995,1(2):159-162
29 Albala C, Yanez M , Devoto E, et al. Obesity as a protective factor for
postmenopausal ostoporosis . Int J Obes Metab Disord, 1996,20:1027-1032.
30 Pichard, C, Kyle UG, Janssens JP, et al. Body composition by X-ray absorptiometry and bioelectrical impedance in chronic respiratory insufficiency patients .1997 ,13:952-958.
31 Madden AM, Morgan My. The potential role of Dual-energy X-ray absorptiometry in the assessment of body composition in cirrhotic patients. Nutrition ,1997, 13:40-45.
32 Pichard C, kyle UG, Slos man DO. Fat-free mass in chronic illness: Comparison of bioelectrical impedance and Dual-energy X-ray absorptiometry in 480 chronically ill and healthy subjects. Nutrition, 1999, 15 :668-676.