臺灣博碩士論文加值系統

骨質疏鬆症（Osteoporosis）是一種多致病因子疾病，當骨骼內的礦物質（鈣）流失，導致骨組織內的小樑骨（海綿骨）減少，骨骼變得脆弱，常因輕微的外力導致骨折，嚴重的甚至造成脊椎骨或髖關節等位置的骨折。臨床上是以檢測骨質密度值（bone mineral density；BMD）狀況來評估該病症的等級及作為治療的指標。目前臨床上檢查的方法有單光子的核子吸收儀（single-photon absorptiometry）、雙光子的核子吸收儀(dual-photon absorptiometry)、放射線骨密度量測法(radiographic absorptiometry)、單能量的X光吸收儀（single-energy X-ray absorptiometry）、雙能量的X光吸收儀（dual-energy X-ray absorptiometry；DEXA）、定量式電腦斷層骨質測定儀（quantitative computed tomography）、磁振造影掃描儀（magnetic resonance imaging）及定量式超音波測定儀（quantitative ultrasound；QUS）等。因為各種檢查設備的工作原理及系統設計的不同，故各有其優缺點及適用的範圍。近年來隨著DEXA和QUS兩種檢測方式被廣泛的使用，已成為最主要檢測骨質密度值及預測骨折發生率的設備。
本研究主要目的是在比較DEXA和QUS這兩種診斷檢測方式，樣本是以53位健康的男性（分佈於19~50歲之間）為對象，並將兩種骨質密度檢查之結果相互間及與其身體質量指數（body mass index；BMI）和生活習慣等之相關性的探討與分析。研究方法：首先進行兩種儀器設備的校正及品管工作並記錄分析以判定系統之穩定度及誤差測試；在基本問卷資料部份除了收集身高、體重、身體質量指標與骨質疏鬆之相關危險因子項目等。受檢者先使用DEXA量測脊椎與髖關節位置再檢測超音波之腳跟骨位置，並將結果以統計方法分析其線性迴歸、t-test及單因子變異係數分析。
研究結果發現，兩種設備校正結果顯示儀器本身之穩定度良好(DEXA之CV值=0.05% 和QUS之CV值=2%) ，另將DEXA和QUS這兩種骨密度參數分析其線性相關性不佳(r = 0.472), p<0.001，本實驗並利用兩種方法檢測之骨質密度值和BMI值及生活習慣等因素分析發現體重較瘦的人BMD 值微偏低，另與骨質疏鬆症之危險因素及生活習慣其它項目如曬太陽多寡等並無明顯相關性。結論: 因此診斷結果可能會因為使用不同廠牌及機型的骨質密度儀器，而有明顯的差異。

Osteoporosis is a multifactorial disease that leads to weakness and fragility of the skeleton and increases the risk of fracture. The most common sites of osteoporotic fractures are spine, hip, and wrist joint.
The major methods for diagnosing osteoporosis are based on the measurement of bone mineral density (BMD) that can be achieved by several ways such as radiographic absorptiometry, dual-photon absorptiometry, single-photon absorptiometry, dual-energy X-ray absorptiometry (DXA), single-energy X-ray absorptiometry, quantitative ultrasound (QUS), quantitative computed tomography, and nuclear magnetic resonance. Although all of the above mentioned method are painless, safe and noninvasive, two of them, the DXA and QUS, are becoming more widely used because of their precision and cost-effectiveness.
The study was designed to evaluate the relationships between ultrasound and DEXA measurement of bone mass density. Fifty-three healthy men (aged 19 to 50 years) were recruited in this study. A questionnaire regarding the following risk factors was obtained for each person, including demographic variables (age, sex, marital status, height and body weight), and lifestyle habits (intake of alcohol, tea, coffee, milk, smoking and medical history). All persons received DXA and QUS examination. The former was done by Hologic QDR-2000 bone densitometer measuring at spine and hip while the latter was by Aloka AOS-100 at calcaneus. Linear regression, pair t-test, and One-way analysis of variance (ANOVA) was used to determine the relationship of DXA and QUS.
Results: 1.The in vitro precision errors of both DXA and QUS methods were 0.05% and 2% respectively. 2. There was poor to moderate correlation between the measured data of DXA and QUS , (r = 0.472) p<0.001. 3. The BMI (body weight) was positively correlated with the BMD. All the other demographic variables and life style factors presented with poor correlation to the BMD. Conclusion: The BMD detected with different brands or modalities of bone densitometers may not produce consistent results.

中文摘要………………………………………………………………………i
英文摘要……………………………………………………………………iii
誌謝……………………………………………………………………………v
目錄…………………………………………………………………………vi
圖目錄………………………………………………………………………vii
表目錄………………………………………………………………….……ix
第一章 緒論…………………………………………………………………1
1.1 背景簡介……………………………………………………......……1
1.2 研究動機…………………………………………………………......3
1.3 文獻回顧…………………………………………………………......4
第二章 臨床量測骨質密度的原理及方法………………………………..6
2.1 何謂骨質密度值…………………………………………………......6
2.2 測量骨質密度的方式及原理…………………………………….....8
2.3 超音波骨質量測系統………………………………………………16
2.4 利用X-光技術量測骨質密度………………………………………26
第三章 實驗方法及步驟…………………………………………………35
3.1 研究架構的建立……………………………………………………35
3.2 實驗設備及檢查方法………………………………………………37
3.3 統計分析方法………………………………………………………46
3.4 系統設備之校正及自身測試………………………………………51
第四章 結果與討論………………………………………………………55
4.1 研究對象的基本資料統計…………………………………………55
4.2 DEXA與QUS檢測骨質密度值結果之比較……………………………57
4.3 DEXA與QUS檢測骨質密度值與生活習性之相關性研究結果………64
4.4 儀器設備本身測量之變異情形……………………………………67
4.5 討論…………………………………………………………………68
第五章 結論與建議………………………………………………………69
參考文獻……………………………………………………………………71
附 錄 A骨質密度檢查問卷表……………………………………………73
附 錄 B QUS檢測及危險因子部分樣本統計結果………………………75
附 錄 C精確度計算公式…………………………………………………76
附 錄 D MINITAB統計分析方法…………………………………………77
附 錄 E 骨質疏鬆症之理論基礎…………………………………………80
授權書………………………………………………………………………90

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