中国骨质疏松杂志

QCT和DXA对腰椎骨质疏松症检出率的Meta分析

Osteoporosis detection in lumbar spine by QCT and DXA: a Meta-analysis

DOI：10.3969/j.issn.1006.7108.2022.10.006

英文关键词:osteoporosis bone mineral density quantitative CT dual-energy X-ray absorptiometry Meta analysis

基金项目:国家自然科学基金（膳食炎性程度和色氨酸及其交互效应与老年糖尿病人骨质健康相关性的研究）（82003541），国家自然科学基金（基于微结构MR成像的有限元模型定量分析老年髋部脆性骨折风险）（81901718）；北京市医院管理中心临床医学发展专项（肌骨影像学）（ZYLX202107）；湖南省教育厅优秀青年项目（色氨酸与老年糖尿病人骨微结构健康的相关性及其影响因素研究）（20B367）

作者	单位
谭安芬1 曾雪晴1 王玲2,3 程晓光2 毛志群4 刘鹏4 黄锋4 苏怡1*	1.湖南师范大学医学院“分子流行病学”湖南省重点实验室，湖南长沙 410003 2.北京积水潭医院放射科，北京 100035 3.云南省第一人民医院放射科，云南昆明 650000 4.湖南省人民医院(湖南师范大学附属第一医院)放射科，湖南长沙 410005

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中文摘要:

目的通过对定量CT（quantitative computed tomography，QCT）和双能X线吸收测量仪(dual-energy X-ray absorptiometry，DXA）腰椎骨质疏松症(osteoporosis ,OP)检出率研究数据进行Meta分析，了解QCT和DXA对腰椎OP的诊断价值。方法检索 PubMed、Web of Science、Cochrane Library、万方、维普及中国知网中自建库以来至2022年1月1日的相关文献，提取目标数据。采用Stata 11.0软件进行数据分析，根据异质性检验结果选择固定效应模型或随机效应模型对数据进行汇总分析。结果共纳入24篇研究，总样本量为4 008例，其中男性2 265例，女性1743例。24项研究间异质性显著，按随机效应模型分别汇总QCT和DXA对腰椎OP检出率为0.44(95 %CI：0.37~0.52)和0.17(95 %CI：0.14~0.21)。QCT对男、女性腰椎OP检出率分别为0.32(95 %CI：0.22~0.43)和0.45(95 %CI：0.33~0.58)，DXA则分别为0.14(95 %CI：0.08~0.20)和0.24(95 %CI：0.17~0.30)。QCT在45~、60~岁和75岁及以上的人群中腰椎OP检出率分别为0.41(95 %CI：0.21~0.61)、0.43(95 %CI：0.33~0.54)和0.48(95 %CI：0.41~0.54)，DXA则分别为0.30(95 %CI：0.12~0.49)、0.16(95 %CI：0.11~0.20)和0.15(95 %CI：0.10~0.21)。QCT和DXA对国内人群腰椎OP检出率分别为0.40(95 %CI：0.33~0.47)和0.15(95 %CI：0.12~0.19)，对国外人群分别为0.68(95 %CI：0.43~0.93)和0.28(95 %CI：0.18~0.39)。QCT与DXA对腰椎OP检出率的差值(率差)定量合并结果为0.25(95 %CI：0.20~0.31)，在男性为0.26(95 %CI：0.18~0.34)，在女性为0.28(95 %CI：0.17~0.39)，在45~、60~岁和75岁及以上人群中分别为0.10(95 %CI：0.06~0.14)、0.26(95 %CI：0.19~0.33)和0.30(95 %CI：0.18~0.41)，及在国内外人群分别为0.23(95 %CI：0.17~0.29)和0.38(95 %CI：0.13~0.64)。结论 QCT比DXA对腰椎OP的检出率高，且QCT对男、女性和各年龄段及不同地区间人群的腰椎OP检出率均高于DXA，率差值随年龄的增加而增大，提示QCT对高年龄组腰椎OP的早期发现可能具有更高的价值。

英文摘要:

Objective To determine the detection rate of osteoporosis in lumbar spine by quantitative computed tomography and dual-energy X-ray absorptiometry, respectively, based on literature review via a meta-analysis. Potential con-founders will be explored, so as to improve the efficiency of osteoporosis detection. Methods Literature retrieved from PubMed, Web of Science, Cochrane Library, Wan Fang Data, VIP and CNKI up to Jan 01, 2022 were systematically reviewed. STATA 11.0 software was used for data-analysis, while fixed effect model or random effect model was used to pool study-specific effect sizes (ESs) and 95% confidence intervals (CIs). Results 24 studies were included, with a total sample size of 4008 subjects. The summary detection rate of QCT and DXA for osteoporosis was 0.44(95%CI: 0.37-0.52) and 0.17(95%CI: 0.14-0.21), respectively. And the rate was 0.32(95%CI: 0.22-0.43) and 0.14(95%CI: 0.08-0.20) in male, while 0.45(95%CI:0.33-0.58) and 0.24(95%CI:0.17-0.30) in female, respectively. Osteoporosis detection rate by QCT in people aged 45~, 60~ and 75 years old and above was 0.41(95%CI: 0.21-0.61), 0.43(95%CI: 0.33-0.54) and 0.48(95%CI: 0.41-0.54), respectively. And the age-grouped rate by DXA was 0.30(95%CI: 0.12-0.49), 0.16(95%CI: 0.11-0.20) and 0.15(95%CI: 0.10-0.21), respectively. The detection rate of QCT and DXA for osteoporosis was 0.40(95%CI: 0.33-0.47) and 0.15(95%CI:0.12-0.19) in domestic population, and was 0.68(95%CI: 0.43-0.93) and 0.28(95%CI: 0.18-0.39) in population overseas, respectively. The difference of detection rate between QCT and DXA was 0.25(95%CI: 0.20-0.31), while 0.26(95%CI: 0.18-0.34) in male and 0.28(95%CI: 0.17-0.39) in female. The difference of detection rate between QCT and DXA in 45~, 60~ and 75 years old and over was 0.10(95%CI: 0.06-0.14), 0.26(95%CI: 0.19-0.33) and 0.30(95%CI: 0.18-0.41), respectively. The difference in osteoporosis detection rate between QCT and DXA was 0.23(95%CI: 0.17-0.29) in China and 0.38(95%CI: 0.13-0.64) abroad. Conclusions Detection rate of lumbar spine osteoporosis by QCT is higher than that by DXA, irrespective of genders, groups of age, and regions. The difference of rate increases with advanced age, which suggests that QCT may benefit for the early detection of lumbar spine osteoporosis in older adults.

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