骨質(zhì)疏松癥流行病學(xué)的標(biāo)一化研究中國醫(yī)科大學(xué)航空總醫(yī)院脊柱外科張智海Background:

背景DifferenttypesBMDmachinesinChinaDifferentresultsgotbythesemachinesHowtodecidewhichoneshouldbethe“GoldenStandard”ofosteoporosis國內(nèi)骨密度儀種類繁多、型號不一結(jié)果不同缺乏診斷“金標(biāo)準(zhǔn)”精選課件Requirements

需求ComparisonsinEpidemiologyThescoreofosteoporoticdiagnosis流行病學(xué)數(shù)據(jù)互相比較骨質(zhì)疏松診斷參考值主要DXA設(shè)備

LUNAR

HOLOGIC

NORLAND診斷標(biāo)準(zhǔn)T值<-2.5SDT值<-2.0SD精選課件研究進(jìn)展SpineHologicQDR-2000=(0.906×LunarDPX-L)-0.025HologicQDR-2000=(0.912×NorlandXR26)+0.088LunarDPX-L=(1.074×HologicQDR-2000)+0.054LunarDPX-L=(0.995×NorlandXR26)+0.135NorlandXR26=(0.983×LunarDPX-L)-0.012NorlandXR26=(1.068×HologicQDR-2000)-0.070NeckHologicQDR-2000=(0.836×LunarDPX-L)-0.008HologicQDR-2000=(0.836×NorlandXR26)+0.051LunarDPX-L=(1.013×HologicQDR-2000)+0.142LunarDPX-L=(0.945×NorlandXR26)+0.115NorlandXR26=(0.961×LunarDPX-L)-0.037Norland

XR26=(1.030×Hologic

QDR-2000)+0.058conversionformulas(U.S.A.)***AmericanSocietyforBoneandMineralResearch,JournalofBoneandMineralResearch1997.12:1316-13171997年精選課件SpineDPX-L=1.2107×QDR-1000-0.0512XR-26=1.0969×QDR-1000-0.1056QDR-2000=0.9602×QDR-1000+0.0161QDR-4500=0.9974×QDR-2000-0.0124EXP-5000=1.0243×DPX-L-0.0120NeckDPX=1.294×QDR-1000-0.092XR=1.142×QDR-1000-0.120EXP-5000=1.018×DPX=0.0519QDR-1000=1.007×QDR-2000-0.011QDR4500=0.960×QDR-2000+0.031TROCHDPX=1.190×QDR-1000+0.001XR=1.118×QDR-1000-0.045QDR1000=1.037×QDR-2000+0.025QDR-4500=0.989×QDR-2000+0.017conversionformulas(JAPAN)日本***福永仁夫串田一博骨密度測定儀器互換性研究委員會成果報(bào)告OsteoporosisJapan2002,10(3):41-42）研究進(jìn)展2002年精選課件2005年精選課件Methods

研究方法MaterialssourcesDataExtractedFrompaperspublishedinChina（magazines）from1999to2004OnlyincludeBMDresultsofDEXAmachines材料來源1994---2004國內(nèi)各期刊發(fā)表

DEXA法骨密度測量數(shù)據(jù)精選課件Total:137，929case—timesFemaledataenrolledintheitem總計(jì)137，929例次女性

（僅包括腰椎正位、股骨頸和股骨TROCH區(qū)）

LUNAR-DPX-L46,744例次

LUNAR-EXPERT20,748例次

LUNAR-DPX-IQ5,507例次

NORLAND-XR13,812例次

HOLOGIC-QDR450042,158例次

HOLOGIC-QDR20008,960例次另：男性76,207例次(未記入）Methods

研究方法

精選課件CalculatethesedatabySPSS(Version11.0)softwareindifferentmachines,typesandmeasuringpositions計(jì)算軟件SPSS11.0不同儀器不同型號不同測量部位Methods

研究方法精選課件MostpopularlyUsedinChinaLUNAR—DPX-LCalculatetheconversionformulas國內(nèi)最多使用LUNAR—DPX-L推算換算公式Methods

研究方法精選課件LUNAR—DPX-L（46，744time-cases）

NORLAND-XR（13，812time-cases）Results

結(jié)果LUNAR—DPX-LNORLAND-XRconversionformulasNMEANSDNMeanSD20-15501.12860.04203431.00170.0430LUNARDPX-L=NORLAND-XR×1.126+0.006930-24101.15780.04228671.04380.0392LUNARDPX-L=NORLAND-XR×1.109+0.000240-46501.11780.045025021.01000.0389LUNARDPX-L=NORLAND-XR×1.106+0.0007450-80540.99800.046916370.92400.0430LUNARDPX-L=NORLAND-XR×1.080+0.0000860-82850.89550.06568350.81400.0420LUNARDPX-L=NORLAND-XR×1.100+0.000170-43610.86350.06392400.79200.0874LUNARDPX-L=NORLAND-XR×1.090+0.0002280-10840.80190.0576180.62600.0540LUNARDPX-L=NORLAND-XR×1.280+0.0006290-1700.86400.1316平均公式：LUNARDPX-L=NORLAND-XR×1.102+0.00137LUMBAR

2--4精選課件Results

結(jié)果LUNAR—DPX-LNORLAND-XRconversionformulas

NMeanSDNMeanSD20-4900.91330.10751590.86680.0054LUNARDPX-L=NORLAND-XR×1.053+0.0005630-7180.93860.03633900.90060.0065LUNARDPX-L=NORLAND-XR×1.042+0.0001740-10650.89260.038217300.86530.0025LUNARDPX-L=NORLAND-XR×1.031+0.00004750-17020.79960.03859400.79540.0091LUNARDPX-L=NORLAND-XR×1.005+0.0002260-22230.70720.03453640.70260.0048LUNARDPX-L=NORLAND-XR×1.006+0.0003870-14560.65440.0470910.61380.0300LUNARDPX-L=NORLAND-XR×1.066+0.0000980-4010.59810.0203110.56340.1072LUNARDPX-L=NORLAND-XR×1.061+0.0003390-350.58200.0129平均公式：LUNARDPX-L=NORLAND-XR×1.0377+0.00026NECKLUNAR—DPX-L（46，744time-cases）

NORLAND-XR（13，812time-cases）精選課件Results

結(jié)果LUNAR—DPX-LNORLAND-XRconversionformulas

NMeanSDNMeanSD20-4900.75410.06631590.69130.0047LUNARDPX-L=NORLAND-XR×1.09+0.00058330-7180.77520.06633900.71710.0213LUNARDPX-L=NORLAND-XR×1.081+0.00001540-10650.75200.071617300.68170.0066LUNARDPX-L=NORLAND-XR×1.103+0.00008550-17020.68480.05209400.61580.0506LUNARDPX-L=NORLAND-XR×1.112+0.0000360-22230.61880.05793640.53700.0678LUNARDPX-L=NORLAND-XR×1.152+0.0001770-14560.57850.0690910.46290.0380LUNARDPX-L=NORLAND-XR×1.249+0.0003380-4010.54470.0279110.44990.0730LUNARDPX-L=NORLAND-XR×1.176+0.015690-350.49980.0099平均公式：LUNARDPX-L=NORLAND-XR×1.137+0.0021TrochLUNAR—DPX-L（46，744time-cases）

NORLAND-XR（13，812time-cases）精選課件LUNAR—DPX-L

（46，744time-cases）

NORLAND-XR（13，812time-cases）Results

結(jié)果LUNAR-DPX-L=NORLAND-XR

×1.092+0.0012

conversionformulas轉(zhuǎn)換系數(shù)9.2%Difference!精選課件Results

結(jié)果LUNAR-DPX-L（46,744time-cases）

LUNAR-EXPERT（20,748time-cases)2%Difference!conversionformulas轉(zhuǎn)換系數(shù)LUNARDPX-L=LUNAR-EXPERT×0.980+0.00706

精選課件Results

結(jié)果LUNAR-DPX-L（46,744time-cases）

LUNAR-DPX-IQ（5,507time-cases)0.06%Difference!conversionformulas轉(zhuǎn)換系數(shù)LUNAR-DPX-L=LUNAR-DPX-IQ×0.994+0.00028精選課件Results

結(jié)果16.2%Difference!conversionformulas轉(zhuǎn)換系數(shù)LUNAR-DPX-L（46,744time-cases）

HOLOGIC-QDR2000

（9,059time-cases)LUNAR-DPX-L=HOLOGIC-QDR2000×1.162+0.00036精選課件Results

結(jié)果11.9%Difference!conversionformulas轉(zhuǎn)換系數(shù)LUNAR-DPX-L=HOLOGIC-QDR4500×1.119+0.0094LUNAR-DPX-L（46,744time-cases）

HOLOGIC-QDR4500

（44,524time-cases)精選課件Conclusions

結(jié)論BMDValuesaredifferentamongdifferenttapesmachine!不同儀器BMD數(shù)值不同LUNARHOLOGICNORLAND>>≈9%≈3%精選課件Conclusions

結(jié)論EQUALBASICLY

結(jié)果基本相同conversionformulas轉(zhuǎn)換系數(shù)CHINAUSAJAPAN

中美日RACEANDSTATISTICBI