| 摘要: | 目的：預防骨質疏鬆症已是現代生活所必需面對的疾病，為提供醫師充分資訊，並利用最少量的檢查得到正確的臨床診斷以降低病人暴露輻射劑量之風險是非常重要議題。本研究的主要目的在於建立骨質密度(BMD)檢測部位的預測模式並評估人口變項、生活型態、婦科經歷等因素與骨質密度檢測部位的關係。
方法：本研究係針對117位女性（年齡介於20.8~82.9歲之間），利用雙能X光吸收儀（GE-Lunar, prodigy）量測全身、腰椎及左右髖部等部位之骨質密度，並以訪談式的問卷收集樣本的基本人口變項與生活型態，飲食習慣，健康狀況等變項資料，利用變異數分析、邏輯斯迴歸等分析方式建立骨密檢測部位之預測模式，並以相關分析與線性迴歸探討影響骨密之相關因子。
結果：研究結果發現右髖部骨質密度與左髖部骨質密度沒有顯著差異。年齡、身高、停經年齡及停經時間等變項在最低T-score部位的不同分組間有顯著差異（p<0.05）。多元邏輯斯迴歸分析結果顯示，葷素食、是否吃魚及是否喝咖啡等變項與最低T-score部位有關。線性迴歸分析結果顯示，不同部位之T-score及骨質(BMD)均與年齡、體重有顯著相關。
結論：從研究結果發現：（1）除非有特別的原因，否則髖部不需要兩側皆檢測，且同時檢測腰椎及單側髖部即可使臨床符合度達87.3%。（2）年齡較小、身高較高、停經年齡較小、停經時間較短者，宜檢測髖部。（3）多元邏輯斯分析結果顯示全素食者宜檢查髖部；奶蛋早素者、不吃魚者、沒有喝咖啡習慣者宜檢查腰椎。（4）影響全身BMD與T-score為年齡及體重，影響腰椎BMD與T-score為年齡、體重及平均每天看幾小時電視，影響左右髖部BMD與T-score為年齡及體重。
建議：（1）骨質密度檢測應同時檢測腰椎及單側髖部，或者應用本研究之結果來決定適當的檢測部位，以提高臨床符合度。（2）後續研究應繼續追蹤並擴大樣本數以探討各族群及城鄉差異等相關因子對骨質密度之影響。（3）若想要更清楚了解骨密影響因子與骨質密度的因果關係，則需以一個族群為基礎，進行世代研究。（4）由本研究結果得知，年紀較大之女性，其體重與骨質密度有顯著的正相關，因此建議要有均衡的飲食並維持適當的體重以保存骨本。
Objectives: Prevention of osteoporosis is already an important issue which we must face in the modern life. In addition to providing doctors full information, it’s substantial to do fewest exams to obtain the correct clinical diagnosis and reduce the risk of radiation exposure to the subjects. The aim of this study was to set up the predictive model for regional bone mineral density (BMD) examination and to evaluate the relationships between BMD and its related factors, such as population variables, life patterns, gynecological experience, etc.
Methods: This study was in view of 117 females (aged from 20.8 to 82.9 years old) who were examed the BMD of whole body, lumbar spine, and both hips by dual energy X-ray absorpitometry (GE-Lunar, prodigy). We collected the variable data, such as basic population variables, life patterns, diet customs, health statuses, and so on of samples by an interviewed questionnaire. We utilized the analysis of variation (ANOVA) and logistic regression to establish the predictive model of and applied correlation analysis and linear regression to investigate the influence of related factors on regional BMD.
Results: The findings of our study showed no significant difference between the BMD of right hip and left hip. The variables of age, height, age of menopause, and period of menopause etc. revealed significant differences in the lowest T-score regions in different groups. The analysis of linear regression disclosed T-score and BMD of different regions were correlated with age and body weight.
Conclusions: The findings of our study were as fallows. (1) There is no necessary to perform BMD of both hips in one subject except some special reasons. Simultaneous exams of lumbar spine and one hip were adequate to obtain 87.3% of clinical accordance. (2) The hip was a proper region for BMD exam in the subjects with younger age, higher body height, younger age of menopause, or shorter period of menopause. (3) Multiple logistic regression analysis showed that exam region of the hip was appropriate for vegetarians; exam region of the lumbar spine was appropriate for vegetarians with milk and egg consumption, subjects without fish consumption, and subjects without coffee drinking. (4) The factors affected BMD and T-score of whole body, lumbar spine, and both hips were age and body weight. An additional factor that influenced BMD and T-score of lumbar spine was average hours of watching TV.
Suggestions: (1) We suggest performing the BMD exams of lumbar spine and one hip simultaneously, or applying the results of our predictive model to choose a proper region for BMD exams to improve the clinical accordance. (2) On the base of this study, we will keep following our subjects and expand our sample numbers to investigate the effect of ethnic groups, difference between city and countryside, and other related factors on BMD. (3) To clarify the causal relation of BMD and BMD-related factors, a population-based cohort study will be necessary. (4) From the results of this study, we know that the aged females whose body weights were positively correlated to BMD. Thus we suggest having balance diet and appropriate body weight to maintain a good quality of BMD. |
