生物电阻抗法与双能X线吸收法测量儿童青少年骨矿物含量的比较

卢可缘; 姚婉雯; 敖丽萍; 陆爽; 程红; 刘军廷; 郑义锦; 陈超; 米杰; 杨翌; 刘丽

doi:10.16835/j.cnki.1000-9817.2022.02.027

生物电阻抗法与双能X线吸收法测量儿童青少年骨矿物含量的比较

doi: 10.16835/j.cnki.1000-9817.2022.02.027

卢可缘¹,
姚婉雯¹,
敖丽萍¹,
陆爽¹,
程红²,
刘军廷²,
郑义锦¹,
陈超¹,
米杰³,
杨翌¹,
刘丽^1, ,

1.
广东药科大学公共卫生学院流行病与卫生统计学系，广州 510310
2.
首都儿科研究所流行病学研究室
3.
国家儿童医学中心儿童慢病管理中心/首都医科大学附属北京儿童医院

基金项目:

国家自然科学基金项目 81874271

2021年广东省科技创新战略专项资金项目 pdjh2021a0258

详细信息

作者简介:
卢可缘(1997-)，女，广东中山人，在读硕士，主要研究方向为流行病与卫生统计学

通讯作者:
刘丽，E-mail：pupuliu919@163.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R446 R179
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- 被引次数: 0
出版历程
- 收稿日期: 2021-10-08
- 修回日期: 2021-11-13
- 网络出版日期: 2022-02-24
- 刊出日期: 2022-02-25

Comparative analysis of bone mineral content measured by bioelectrical impedance analysis and dual-energy X-ray absorption among children and adolescents

1.
Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou (510310), China

摘要

摘要: 目的评价生物电阻抗法(BIA)与双能X线吸收法(DXA)测量儿童青少年的骨矿物含量(BMC)的一致性，为BIA准确测量儿童青少年BMC提供依据。方法采用方便抽样法，于2019年4—5月在广州市某区招募1 469名7~17岁儿童青少年，采用DXA和BIA技术分别测量BMC。采用组内相关系数(ICC)、Bland-Altman分析评价一致性。Bland-Altman分析在对数转换的数据中进行。将BMC按性别年龄别三分位数分类，计算Kappa值评价一致性。以DXA测量值为因变量，建立BIA校正预测模型。结果男、女生的ICC分别为0.93和0.94。在Bland-Altman分析中，男、女生的BIA与DXA比值的一致性限范围均较宽，分别为0.27~0.76和0.17~0.72。男、女生中两方法判断BMC三分类水平的Kappa值分别为0.57和0.45，呈中高度一致。按BMI分组，各体重状态男生及超重女生的Kappa值均在0.75以上，一致性程度极好。构建的男、女生BIA校正预测模型分别为：BMC_DXA=-0.51+0.44×BMC_BIA+0.06×Age+0.02×BMI; BMC_DXA=-0.55+0.43×BMC_BIA+0.06×Age+0.02×BMI。模型的R²值分别为0.87和0.87。结论 BIA与DXA所测BMC值一致性较差，但在判断分类BMC水平方面一致性尚可，研究建立的BIA测量BMC校正模型拟合效果好，提示BIA可能适用于评估儿童群体的BMC发育水平。
- 生长和发育 /
- 骨和骨组织 /
- 矿物质 /
- 儿童 /
- 青少年
Abstract: Objective To compare bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) for measuring body mineral content (BMC) of children and adolescents, and to provide a basis for BIA to accurately measure BMC in children and adolescents. Methods By using the convenience sampling method, among 1 469 children and adolescents aged 7-17 were recruited in Guangzhou from April to May 2019, the BMC was measured by DXA and BIA. The intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to evaluate the agreement between BIA and DXA. Bland-Altman analysis was performed on log-transformed data. The BMC was categorized into age-and specific-tertiles, and the agreement between methods was evaluated based on the kappa coefficients. Treating the BMC with DXA as the dependent variable, a prediction model was constructed for correcting the BIA measure. Results The ICCs were 0.93 and 0.94 for boys and girls, respectively. In Bland-Altman analysis, the limits of agreements for the BIA-to-DXA ratio were wide in boys and girls, ranging from 0.27-0.76 and 0.17-0.72, respectively. The kappa coefficients for categorized BMC levels were 0.57 and 0.45 for boys and girls, respectively, showing a fair-to-good degree of agreement. When sub-grouped by BMI, the kappa coefficients for all BMI groups of boys and overweight girls were all >0.75, with an excellent agreement. The prediction models for boys and girls were as follows: BMC_DXA=-0.51+0.44×BMC_BIA+0.06×Age+0.02×BMI; and BMC_DXA=-0.55+0.43×BMC_BIA+0.06×Age+0.02×BMI, respectively. The R² for models of boys and girls were 0.87 and 0.87, respectively. Conclusion The agreement between BIA and DXA was poor for measuring BMC, but acceptable when evaluating the categorized BMC levels, suggesting the BIA may be applied in assessment of the BMC levels when compared to the age-and gender-specific population. Additionally, the prediction model for correcting BMC by BIA fis well to the measurement by DXA.
- Growth and development /
- Bone and bones /
- Minerals /
- Child /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 不同组别儿童青少年BIA与DXA测量的BMC结果及相关分析(x±s, kg)

Table 1. BMC results and correlation analysis of BIA and DXA measurements in different groups of children and adolescents(x±s, kg)

组别	男生				女生
组别	人数	DXA	BIA	r值	人数	DXA	BIA	r值
年龄/岁
7	43	0.76±0.08	1.26±0.20	0.71	52	0.72±0.08	1.20±0.16	0.65
8	76	0.81±0.10	1.39±0.19	0.64	63	0.81±0.09	1.41±0.20	0.50
9	35	0.89±0.12	1.51±0.25	0.73	41	0.85±0.10	1.49±0.20	0.67
10	43	0.98±0.15	1.72±0.25	0.69	31	1.04±0.21	1.79±0.32	0.88
11	73	1.08±0.15	1.91±0.28	0.76	48	1.20±0.23	2.03±0.25	0.76
12	89	1.32±0.27	2.35±0.43	0.84	88	1.35±0.21	2.18±0.22	0.62
13	129	1.53±0.29	2.65±0.39	0.82	101	1.49±0.22	2.27±0.21	0.67
14	145	1.75±0.37	2.86±0.48	0.83	101	1.58±0.19	2.29±0.18	0.67
15	82	1.89±0.33	2.94±0.38	0.73	73	1.69±0.25	2.34±0.24	0.79
16	45	2.08±0.35	3.10±0.49	0.75	48	1.79±0.22	2.34±0.24	0.67
17	38	2.17±0.35	3.08±0.41	0.71	25	1.76±0.26	2.36±0.25	0.69
BMI分组
消瘦	128	1.15±0.39	1.90±0.52	0.91	77	1.01±0.36	1.61±0.43	0.92
正常体重	509	1.45±0.49	2.38±0.67	0.91	514	1.37±0.38	2.08±0.41	0.88
超重	95	1.58±0.53	2.69±0.75	0.94	53	1.43±0.41	2.15±0.47	0.93
肥胖	66	1.66±0.63	2.73±0.87	0.95	27	1.31±0.48	2.05±0.53	0.92
合计	798	1.44±0.51	2.37±0.72	0.92	671	1.33±0.40	2.03±0.45	0.90
注： P值均 < 0.01。

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表 2 不同组别儿童青少年BIA与DXA测量BMC的一致性分析

Table 2. Analysis of consistency of BMC measured by BIA and DXA in different groups of children and adolescents

组别	男生					女生
组别	人数	ICC	BIA/DXA	Log_e(BIA)-Log_e(DXA)	LoA	人数	ICC	BIA/DXA	Log_e(BIA)-Log_e(DXA)	LoA
年龄/岁
7	43	0.65	1.66	0.51	0.29~0.72	52	0.70	1.67	0.51	0.31~0.71
8	76	0.68	1.72	0.53	0.31~0.75	63	0.55	1.74	0.56	0.31~0.81
9	35	0.73	1.70	0.52	0.30~0.73	41	0.69	1.75	0.55	0.35~0.76
10	43	0.76	1.76	0.56	0.34~0.78	31	0.90	1.72	0.55	0.37~0.74
11	73	0.77	1.77	0.57	0.37~0.76	48	0.87	1.69	0.53	0.31~0.76
12	89	0.86	1.78	0.58	0.37~0.78	88	0.77	1.61	0.49	0.25~0.73
13	129	0.88	1.73	0.55	0.34~0.77	101	0.80	1.52	0.43	0.20~0.66
14	145	0.89	1.63	0.50	0.26~0.74	101	0.80	1.45	0.37	0.20~0.55
15	82	0.84	1.56	0.45	0.23~0.68	73	0.88	1.38	0.33	0.15~0.51
16	45	0.83	1.49	0.40	0.17~0.62	48	0.81	1.31	0.29	0.11~0.46
17	38	0.82	1.42	0.36	0.12~0.59	25	0.81	1.34	0.30	0.11~0.48
BMI分组
消瘦	128	0.94	1.65	0.52	0.27~0.76	77	0.95	1.59	0.49	0.22~0.76
正常体重	509	0.93	1.64	0.51	0.25~0.76	514	0.93	1.52	0.43	0.16~0.71
超重	95	0.94	1.70	0.55	0.33~0.77	53	0.96	1.50	0.43	0.19~0.67
肥胖	66	0.95	1.64	0.52	0.29~0.75	27	0.96	1.56	0.48	0.20~0.76
合计	798	0.93	1.65	0.51	0.27~0.76	671	0.94	1.53	0.44	0.17~0.72
注： P值均 < 0.01。

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表 3 不同性别儿童青少年BIA与DXA测量BMC构成情况

Table 3. Composition of BMC measured by BIA and DXA in children and adolescents of different genders

性别	BIA所测BMC	人数	DXA所测BMC
性别	BIA所测BMC	人数	Q1	Q2	Q3
男	Q1	253	180(67.67)	63(23.51)	10(3.79)
	Q2	272	78(29.32)	135(50.37)	59(22.35)
	Q3	273	8(3.01)	70(26.12)	195(73.86)
女	Q1	210	130(58.82)	64(28.83)	16(7.02)
	Q2	231	76(34.93)	95(42.79)	60(26.32)
	Q3	230	15(6.79)	63(28.38)	152(66.67)
注： ()内数字为构成比/%。

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表 4 不同性别儿童青少年BIA法测量BMC的校正预测模型

Table 4. Corrected model for predicting BMC by BIA in children and adolescents of different genders

性别	常量与自变量	β值	标准误	t值	P值
男	常量	-0.51	0.03	-8.90	< 0.01
(n=798)	BMC	0.44	0.03	21.63	< 0.01
	年龄	0.06	0.00	9.29	< 0.01
	BMI	0.02	0.00	2.84	0.01
女	常量	-0.55	0.03	-16.57	< 0.01
(n=671)	BMC	0.43	0.03	16.59	< 0.01
	年龄	0.06	0.00	16.18	< 0.01
	BMI	0.02	0.00	6.79	< 0.01

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参考文献(16)

[1]	MARRA M, SAMMARCO R, DE LORENZO A, et al. Assessment of body composition in health and disease using Bioelectrical Impedance Analysis (BIA) and Dual Energy X-ray Absorptiometry (DXA): a critical overview[J]. Contrast Med Mol Imag, 2019: 3548284. DOI: 10.1155/2019/3548284.
[2]	BARANAUSKAS M, JABLONSKIENÉ V, ABARAVIĈIUS J A, et al. Dietary acid-base balance in high-performance athletes[J]. Int J Environ Res Public Health, 2020, 17(15): 5332. doi: 10.3390/ijerph17155332
[3]	FUKUOKA Y, NARITA T, FUJITA H, et al. Importance of physical evaluation using skeletal muscle mass index and body fat percentage to prevent sarcopenia in elderly Japanese diabetes patients[J]. J Diab Invest, 2019, 10(2): 322-330. doi: 10.1111/jdi.12908
[4]	CHIPLONKAR S, KAJALE N, EKBOTE V, et al. Reference centile curves for body fat percentage, fat-free mass, muscle mass and bone mass measured by bioelectrical impedance in asian indian children and adolescents[J]. Indian Pediatr, 2017, 54(12): 1005-1011. doi: 10.1007/s13312-017-1201-4
[5]	DI I N, MARUCA K, PATTI G, et al. Update on bone density measurements and their interpretation in children and adolescents[J]. Best Pract Res Clin Endocrinol Metab, 2018, 32(4): 477-498. doi: 10.1016/j.beem.2018.06.002
[6]	刘丽, 陆爽, 敖丽萍, 等. 生物电阻抗法和双能X线吸收法测量7~17岁儿童青少年体成分的一致性评价[J]. 中华流行病学杂志, 2021, 42(3): 475-481. doi: 10.3760/cma.j.cn112338-20200812-01062 LIU L, LU S, AO L P, et al. Consistency between bioelectrical impedance analysis and dual-energy X-ray absorptiometry for body composition measurement in children aged 7-17 years[J]. Chin J Epidemiol, 2021, 42(3): 475-481. doi: 10.3760/cma.j.cn112338-20200812-01062
[7]	国家卫生和计划生育委员会. 学龄儿童青少年超重与肥胖筛查: WS/T 586—2018[S]. 北京: 中国标准出版社, 2018. National Health and Family Planning Commission of the PRC. Screening for overweight and obesity in school-age children and adolescents: WS/T 586-2018[S]. Beijing: Standards Press of China, 2018.
[8]	国家卫生和计划生育委员会. 学龄儿童青少年营养不良筛查: WS/T 456—2014[S]. 北京: 中国标准出版社, 2014. National Health and Family Planning Commission of the PRC. Malnutrition screening for school-age children and adolescents: WS/T 456-2014[S]. Beijing: Standards Press of China, 2014.
[9]	ZOU K H, TUNCALI K, SILVERMAN S G. Correlation and simple linear regression[J]. Radiology, 2003, 227(3): 617-622. doi: 10.1148/radiol.2273011499
[10]	KOO T K, LI M Y. A guideline of selecting and reporting intraclass correlation coefficients for reliability research[J]. J Chiropr Med, 2016, 15(2): 155-163. doi: 10.1016/j.jcm.2016.02.012
[11]	BLAND J M, ALTMAN D G. Measuring agreement in method comparison studies[J]. Stat Methods Med Res, 1999, 8(2): 135-160. doi: 10.1177/096228029900800204
[12]	ORSSO C E, SILVA M I B, GONZALEZ M C, et al. Assessment of body composition in pediatric overweight and obesity: a systematic review of the reliability and validity of common techniques[J]. Obes Rev, 2020, 21(8): e13041.
[13]	詹思延, 叶冬青, 谭红专, 等. 流行病学[M]. 8版. 北京: 人民卫生出版社, 2017: 127-128. ZHAN S Y, YE D Q, TAN H Z, et al. Epidemiology[M]. 8 ed. Beijing: People's Medical Publishing House, 2017: 127-128.
[14]	周宇豪, 许金芳, 贺佳. 诊断试验一致性评价中几种方法的比较及应用[J]. 中国卫生统计, 2011, 28(1): 40-42, 46. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT201101045.htm ZHOU Y H, XU J F, HE J. Evaluation and application on different assessment methods of consistency of diagnostic test[J]. Chin J Health Stat, 2011, 28(1): 40-42, 46. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT201101045.htm
[15]	STONE T M, WINGO J E, NICKERSON B S, et al. Comparison of bioelectrical impedance analysis and dual-energy X-ray absorptiometry for estimating bone mineral content[J]. Int J Sport Nutr Exerc Metab, 2018, 28(5): 542-546. doi: 10.1123/ijsnem.2017-0185
[16]	LEE L W, LIAO Y S, LU H K, et al. Validation of two portable bioelectrical impedance analyses for the assessment of body composition in school age children[J]. PLoS One, 2017, 12(2): e0171568. doi: 10.1371/journal.pone.0171568