慢性乙型肝炎患者骨量减少/骨质疏松的危险因素及CT值的诊断价值  

Risk factors for osteopenia/osteoporosis and the diagnostic value of CT value in patients with chronic hepatitis B

作　　者：张静怡 唐映梅[1] 李嘉琦 王倩 张宸瑞 ZHANG Jingyi;TANG Yingmei;LI Jiaqi;WANG Qian;ZHANG Chenrui(Department of Gastroenterology,The Second Affiliated Hospital of Kunming Medical University,Kunming 650000,China;Department of Radiology,The Second Affiliated Hospital of Kunming Medical University,Kunming 650000,China)

机构地区：[1]昆明医科大学第二附属医院消化内科,昆明650000 [2]昆明医科大学第二附属医院放射科,昆明650000

出　　处：《临床肝胆病杂志》2022年第5期1041-1047,共7页Journal of Clinical Hepatology

基　　金：国家自然科学基金(81660102,81360072)。

摘　　要：目的评价在慢性乙型肝炎患者腹部CT中通过测量胸、腰椎CT值,诊断骨量减少/骨质疏松的诊断价值。分析慢性乙型肝炎患者发生骨量减少/骨质疏松的危险因素。方法回顾性纳入2019年1月—2020年12月在昆明医科大学第二附属医院就诊的慢性乙型肝炎患者112例,所有患者均完善了腹部CT检查,部分患者完善了双能X线骨密度测定(DXA)。测量T12椎体至L3椎体的CT值,分析每一椎体CT值与DXA检查基于L1~L4椎体测得的T-score值相比诊断骨量减少/骨质疏松的诊断价值。以椎体CT值为诊断标准,将纳入的慢性乙型肝炎患者分为骨量减少/骨质疏松组(n=55)与骨量正常组(n=57),对比两组患者临床特征、生化指标,分析慢性乙型肝炎患者发生骨量减少/骨质疏松的危险因素。符合正态分布的计量资料两组间比较采用t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ^(2)检验、Fisher确切检验、Bonferroni校正检验。相关性采用Pearson相关分析。多因素分析采用二元logistic回归分析。根据受试者工作特征曲线(ROC曲线)评估T12~L3椎体CT值诊断慢性乙型肝炎患者合并骨量减少/骨质疏松的诊断价值。一致性检验采用Kappa检验。结果分析46例在同次住院中完善了腹部CT和DXA检查患者的T12~L3椎体CT值,均分别与DXA检查结果中基于L1~L4椎体计算的T-score值有显著正相关性(r_(T12)=0.694,r_(L1)=0.661,r_(L2)=0.781,r_(L3)=0.685,P值均<0.001);经ROC曲线分析,L2椎体CT值ROC曲线下面积最大(0.863),诊断骨量减少/骨质疏松具有较好准确性,与DXA检查结果具有较好一致性(K=0.648,P<0.001)。分析112例慢性乙型肝炎患者临床特征、生化指标,提示高龄(比值比为1.108,95%CI:1.026~1.196,P=0.009)、合并肌少症(比值比为2.788,95%CI:1.009~7.707,P=0.048)是骨量减少/骨质疏松发生的危险因素。结论慢性乙型肝炎患者常需定期复查�Objective To investigate the value of the CT values of thoracolumbar vertebrae measured by abdominal CT in the diagnosis of osteopenia/osteoporosis in patients with chronic hepatitis B,as well as the risk factors for osteopenia/osteoporosis in such patients.Methods A retrospective analysis was performed for 112 patients with chronic hepatitis B in the Second Affiliated Hospital of Kunming Medical University from January 2019 to December 2020.All patients underwent abdominal CT,and some patients underwent dual-energy X-ray absorptiometry(DXA).The CT values of T12 vertebral body to L3 vertebral body were measured,and the value of CT value of each vertebral body in the diagnosis of osteopenia/osteoporosis was analyzed in comparison with T-score of L1-L4 vertebral bodies measured by DXA.With the CT values of vertebral bodies as the diagnostic criteria,the patients with chronic hepatitis B enrolled were divided into osteopenia/osteoporosis group with 55 patients and normal bone mass group with 57 patients.Clinical features and biochemical parameters were compared between the two groups to analyze the risk factors for osteopenia/osteoporosis in patients with chronic hepatitis B.The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the chi-square test,the Fisher’s exact test,and the Bonferroni correction test were used for comparison of categorical data between groups.A Pearson correlation analysis was performed to investigate correlation,and a binary logistic regression analysis was used for multivariate analysis.The receiver operating characteristic(ROC)curve was used to investigate the value of CT values of T12-L3 vertebral bodies in the diagnosis of osteopenia/osteoporosis in patients with chronic hepatitis B.The Kappa test was used check consistency.Results A total of 46 patients who completed abdominal CT and DXA during the same time of hospitalization were analyzed,a

关 键 词：乙型肝炎 慢性 骨质疏松 肌减少症 

分 类 号：R51[医药卫生—内科学]