常规CT值定量评价慢性肾病患者腰椎骨量的可行性研究  

A feasibility study of quantitative evaluation of lumbar bone quality in patients with chronic kidney disease using conventional CT

作　　者：和建伟[1] 周小娜 马小梅[1] 曹剑仓 王莉莉[1] 王平[1] He Jianwei;Zhou Xiaona;Ma Xiaomei;Cao Jiancang;Wang Lili;Wang Ping(Department of Radiology,Gansu Provincial Hospital,Lanzhou 730000,China;Department of Radiology,Zhengning County Hospital of Chinese Medicine,Qingyang 745300,Gansu,China)

机构地区：[1]甘肃省人民医院放射科,甘肃兰州730000 [2]正宁县中医医院放射科,甘肃庆阳745300

出　　处：《兰州大学学报（医学版）》2024年第11期45-51,59,共8页Journal of Lanzhou University（Medical Sciences）

基　　金：甘肃省青年科技基金计划资助项目(21JR7RA639);甘肃省人民医院院内科研基金资助项目(21GSSYB-20,23GSSYF-4)。

摘　　要：目的探索应用计算机断层扫描(CT)代替骨密度(BMD)进行骨量评估的可行性,分析慢性肾病(CKD)患者的临床分期与腰1、2椎体CT值之间的关系。方法回顾性收集2023年1—12月在甘肃省人民医院同时做定量CT(QCT)和腹部CT的健康体检者影像学资料,分别测量腰1、2椎体CT值,并以QCT为骨量标准,观察腰1、2椎体CT值与BMD的相关性;调阅在本院曾行腹部CT平扫的CKD患者临床及影像学资料,测量腰1、2椎体CT值,分析不同临床分期CKD患者的腰椎CT值之间的差异;对不同分期CKD患者的实验室检查结果进行单因素方差分析,并以“腰1、2椎体平均CT值”作为因变量,“实验室检查”作为自变量,进行多元线性回归分析。结果腰1、2椎体CT值与QCT测得的BMD值之间的相关系数分别为0.888、0.892,且界定骨量正常、减低与骨质疏松的CT截断值分别130.275、87.250 HU,随着临床分期的增加,CT值减低,患者的血清甲状旁腺激素、磷逐渐减低;CKD患者腰1、2椎体平均CT值与甲状旁腺激素有线性回归关系(P=0.045)。结论腰1、2椎体CT值与QCT测得的BMD值相关性良好,常规CT测得的腰1、2椎体的CT值能够反映椎体骨量情况,因此可以用来评估CKD患者的骨量丢失情况。Objective Firstly,to explore the feasibility of using CT value instead of bone mineral density(BMD)to evaluate bone quality and then to analyze the relationship between clinical stage and CT value of of lumbar vertebra 1 and 2 in patients with chronic kidney disease.Method The imaging data of healthy subjects who underwent quantitative computed tomography(QCT)and abdominal CT in Gansu Provincial People's Hospital from January to December 2023 were retrospectively collected.The CT values of lumbar vertebra 1 and 2 were respectively measured,and QCT used as the bone mass standard to observe the correlation between CT values of lumbar 1,2 vertebra and the bone mineral density.Then,the clinical and imaging data of patients with chronic kidney disease who had undergone abdominal CT scan were reviewed,and the CT values of lumbar 1,2 vertebra were measured to analyze the differences between clinical stages of chronic kidney disease and lumbar CT values.ANOVA was performed on laboratory examination results of patients with different stages of CKD.Finally,multiple linear regression analysis was conducted with"average CT values of lumbar vertebra 1 and 2"as dependent variables and laboratory examination as independent variables to explore the possible causes of bone mass loss caused by chronic kidney disease.Results The correlation coefficients between CT values of lumbar vertebrae 1,2 and BMD values measured by QCT were 0.888 and 0.892,respectively,and the CT truncation values that defined normal bone mass,reduced bone mass and osteoporosis were 130.275 and 87.250 HU,respectively.Moreover,with the increase of the clinical stage,CT value decreased,and blood PTH and blood P of patients gradually decreased.Regression analysis showed that the average CT values of lumbar vertebra 1 and 2 in CKD patients had a linear regression relationship with PTH,and the CT values of vertebral body had the greatest influence(P=0.045).Conclusion There is a good correlation between CT values of lumbar 1,2 vertebra and BMD values measured by QC

关 键 词：慢性肾病 骨量评估 计算机断层扫描 定量计算机断层扫描 骨密度 骨质疏松 

分 类 号：R445.3[医药卫生—影像医学与核医学]