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| 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 |
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| DOI：10.3969/j.issn.1006.7108.2020.03.021 |
| 中文关键词: 99Tc亚甲基二膦酸盐 类风湿关节炎 骨质疏松 定量CT 骨代谢 |
| 英文关键词:technetium99Tc methylene diphosphonate rheumatoid arthritis osteoporosis quantitative computed tomography bone metabolism |
| 基金项目:山东省青岛市医疗卫生重点学科建设项目（V市学科B2017Y10） |
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| 中文摘要: |
| 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 ①MTX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)。②MTX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。 |
| 英文摘要: |
| 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 with β-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. |
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