定量CT用于^99Tc-MDP治疗类风湿关节炎合并骨质疏松的临床研究  

Clinical study of the application of quantitative CT in the evaluation of ^99Tc methylene diphosphonate treatment for osteoporosis patients with rheumatoid arthritis

作　　者：翟红立 王照艳[1] 郁万江[1] 韩合理 徐晓娜[1] 伦晓名 邢倩[1] ZHAI Hongli;WANG Zhaoyan;YU Wanjiang;HAN Heli;XU Xiaona;LUN Xiaoming;XING Qian(Qingdao Municipal Hospital Affiliated Qingdao University Medical College,Qingdao 266071,Shandong,China)

机构地区：[1]青岛大学医学院附属青岛市市立医院,山东青岛266071

出　　处：《中国骨质疏松杂志》2020年第3期407-411,共5页Chinese Journal of Osteoporosis

基　　金：山东省青岛市医疗卫生重点学科建设项目(V市学科B2017Y10)。

摘　　要：目的探讨应用定量CT(quantitative computed tomography,QCT)观察^99Tc亚甲基二膦酸盐(^99Tc-MDP)治疗类风湿关节炎(rheumatoid arthritis,RA)合并骨质疏松症(osteoporosis,OP)患者的疗效及骨代谢情况。方法选取60例住院的RA并发OP患者,随机分成两组,一组给予甲氨蝶呤(methotrexate,MTX)治疗;另一组给予MTX联合^99Tc-MDP治疗。另选取30例原发性OP患者,给予^99Tc-MDP治疗。分别记录治疗前后患者的DAS28评分、视觉模拟评分法(visual analogue scale,VAS)疼痛评分、血清炎性细胞因子、骨转换标志物、双能X线(DXA)及QCT测得的骨密度的变化情况。结果MTX联合^99Tc-MDP组与MTX单药组相比,治疗后患者DAS28评分、VAS疼痛评分、β-CTX显著降低(P<0.05),炎性细胞因子较治疗前下降,但各组之间差异无统计学意义(P>0.05)。(2)MTX联合^99Tc-MDP组治疗前后QCT骨密度值有显著变化(P<0.05),且与β-CTX呈负相关(P<0.05)。(3)应用DXA、QCT计算的10年内主要骨质疏松性骨折概率未见明显差异。结论MTX联合^99Tc-MDP可有效改善类风湿关节炎疾病活动度及骨质疏松,应用QCT检查能早期从影像学上观察到^99Tc-MDP治疗类风湿关节炎合并骨质疏松引起的骨密度变化。Objective To investigate the value of QCT in the efficacy of ^99Tc-MDP treatment for rheumatoid arthritis(RA)patients with osteoporosis.Methods Sixty RA patients with osteoporosis were randomly divided into two groups:one group was administered with MTX,and the other group was administered with MTX and ^99Tc-MDP.Thirty patients with primary osteoporosis were treated with ^99Tc-MDP only.Serum inflammatory factors,bone turnover markers,VAS pain score,and DAS28 score were determined.BMD measured with DXA and QCT was examined before and after the treatment.Results 1)DAS28 score,VAS pain score,β-CTX,and BMD measured by QCT reduced significantly in patients of MTX and ^99Tc-MDP treatment group before and after the treatment(P<0.05).2)BMD measured by QCT was negatively correlated withβ-CTX(P<0.05).3)There was no significant difference in the 10-year probability of a major osteoporotic fracture(PMOF)calculated between DXA and QCT.Conclusion MTX combined with ^99Tc-MDP treatment relieves the disease activity of rheumatoid arthritis and osteoporosis.The change BMD measured with QCT can be observed in the early stage in the treatment of osteoporosis in RA patients.

关 键 词：99Tc亚甲基二膦酸盐 类风湿关节炎 骨质疏松 定量CT 骨代谢 

分 类 号：R684.3[医药卫生—骨科学]