定量CT和双能X线骨密度仪检测女性类风湿关节炎患者骨密度比较  

Comparison of bone mineral density between quantitative CT and DXA in female patients with rheumatoid arthritis

作　　者：刘海波 LIU Haibo(Department of Radiology,Tongzhou Hospital of Traditional Chinese and Western Medicine,Beijing 101100,China)

机构地区：[1]北京市通州区中西医结合医院放射科,北京101100

出　　处：《实用放射学杂志》2020年第6期945-948,共4页Journal of Practical Radiology

摘　　要：目的比较定量CT(QCT)和双能X线骨密度仪(DXA)检测对女性类风湿关节炎(RA)患者和健康志愿者(对照组)骨密度(BMD)检测的效能。方法采用DXA对57例女性RA患者和32例年龄匹配的健康女性对照者BMD进行检测。采用QCT检测受试者前臂超远端区BMD。分析BMD相关数据与年龄、病程、疾病活动度和抗环瓜氨酸肽(CCP)水平的关联。结果与对照组相比,RA患者总BMD[(310.5±79.8)mg/cm^3 vs(354.3±54.4)mg/cm^3;P=0.008]和全衰减[(0.38±0.06)1/cm vs(0.42±0.04)1/cm;P=0.002]、小梁BMD[(157.7±57.3)mg/cm^3 vs(193.6±48.5)mg/cm^3;P=0.006]和衰减[(0.27±0.04)1/cm vs(0.36±0.05)1/cm;P<0.0001]及皮质BMD[(434.4±115.9)mg/cm^3 vs(492.6±64.3)mg/cm^3;P=0.007]和衰减[(0.45±0.08)1/cm vs(0.48±0.03)1/cm;P=0.005]显著降低。与对照组相比,RA组腰椎和股骨颈BMD以及T值评分均显著降低(所有病例P<0.001)。在RA中,QCT全衰减、皮质衰减和BMD与年龄、RA及其结合有关。相比之下,小梁BMD和衰减只受RA影响,而不受年龄影响。同样在RA中,由QCT测定的小梁和皮质BMD与由DXA测定的腰椎和/或股骨颈BMD显著相关。最后,血清抗CCP阳性与较低小梁BMD和衰减有关。结论DXA和QCT均可用于RA骨质疏松症的诊断。DXA测定的区域BMD可能与QCT测量的体积BMD有关。小梁骨质疏松症可能与自身免疫性炎症性疾病有关,皮质骨质疏松症可能与年龄有关。Objective To compare the efficacy of quantitative CT(QCT)and dual energy X-ray absorptiometry(DXA)in detecting bone mineral density(BMD)in female patients with rheumatoid arthritis(RA)and healthy volunteers(control group).Methods BMD of 57 female RA patients and 32 age-matched healthy controls were assessed by DXA.QCT of the forearm ultra-distal region BMD was also performed.Densitometry data were correlated with age,disease duration,disease activity,and anti-CCP levels.Results Compared to control group,the total BMD[(310.5±79.8)mg/cm^3 vs(354.3±54.4)mg/cm^3;P=0.008]and total attenuation[(0.38±0.06)1/cm vs(0.42±0.04)1/cm;P=0.002];trabecular BMD[(157.7±57.3)mg/cm^3 vs(193.6±48.5)mg/cm^3;P=0.006]and attenuation[(0.27±0.04)1/cm vs(0.36±0.05)1/cm;P<0.0001];cortical BMD[(434.4±115.9)mg/cm^3 vs(492.6±64.3)mg/cm^3;P=0.007]and attenuation[(0.45±0.08)1/cm vs(0.48±0.03)1/cm;P=0.005]were significantly lower in RA.Compared with the control group,BMD and T scores of lumbar spine and femoral neck in RA group were significantly lower(P<0.001 in all cases).In RA,total and cortical QCT attenuation and BMD were associated with age,RA and their combination.In contrast,trabecular BMD and attenuation were only affected by PA but not by age.Also in RA,trabecular and cortical BMD as determined by QCT significantly correlated with lumbar and/or femoral neck BMD as measured by DXA.Finally,anti-CCP seropositivity was associated with lower trabecular BMD and attenuation.Conclusion Both DXA and QCT may be suitable to study bone metabolism in RA.Areal BMD determined by DXA may correlate with volumetric BMD measured by QCT.Trabecular osteoporosis may be related to underlying autoimmune-inflammatory disease,the cortical osteoporosis may be age-related.

关 键 词：类风湿性关节炎 双能X线骨密度仪 计算机体层成像 骨密度 女性 

分 类 号：R593.21[医药卫生—内科学] R814.41[医药卫生—临床医学]