中国骨质疏松杂志

QCT与DXA对老年类风湿关节炎患者骨质疏松症诊断价值的对比研究

A comparative study of QCT and DXA in the diagnosis of osteoporosis in elderly patients with rheumatoid arthritis

DOI：10.3969/j.issn.1006-7108.2021.04.002

中文关键词: 类风湿性关节炎双能X线吸收法定量计算机断层扫描法骨密度骨转换标志物

英文关键词:rheumatoid arthritis dual energy X-ray absorptiometry quantitative computed tomography bone mineral density bone turnover marker

基金项目:

作者	单位
刘雪峰1 伦晓名2 郁万江2 韩合理2 翟红立2 邢倩2*	1.潍坊医学院临床医学研究生系，山东潍坊 261000 2.青岛大学附属青岛市市立医院风湿免疫科，山东青岛 266071

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中文摘要:

目的对比研究定量计算机断层扫描法（quantitative computed tomography，QCT）与双能X线吸收法（dual energy X-ray absorptiometry，DXA）在老年类风湿关节炎（rheumatoid arthritis，RA）患者骨质疏松症中的诊断价值。方法选取老年RA患者73例为研究组，选取78例健康老年人为对照组。测定RA组与对照组血清中骨转换标志物（bone turnover marker，BTM）水平，并分别行腰椎（L1-4）、髋部DXA及腰椎（L1-3）、髋部QCT检查，并对两者测量结果进行分析比较。结果 ①QCT对RA组骨质疏松的检出率高于DXA，差异有统计学意义（P<0.05）。②应用受试者操作特性(receiver operating characteristic, ROC)曲线分析显示，QCT诊断RA组腰椎骨质疏松的曲线下面积为0.945，灵敏度93.75 %、特异性87.80 %。③RA组患者血清Ⅰ型胶原羧基端肽β特殊序列(β-cross-linked C-telopeptide of type I collagen，β-CTX)水平比对照组高，血清骨Ⅰ型前胶原氨基端延长肽(procollagen type I N-terminal propeptide，PINP)水平比健康对照组低，差异有统计学意义（P<0.05）。④RA组患者腰椎QCT骨密度（bone mineral density，BMD）值与β-CTX呈负相关（r=?0.81，P<0.05），与PINP呈正相关（r=0.79，P<0.05），而经腰椎DXA测得的BMD无此相关性。结论对于老年RA患者，QCT对骨质疏松检出率高于DXA，具有较好的灵敏度和特异性，且与BTM相关。

英文摘要:

Objective A comparative study on the diagnostic value of quantitative computed tomography (QCT) and dual energy X-ray absorptiometry for osteoporosis in elderly patients with rheumatoid arthritis (RA). Methods Seventy-three elderly RA patients were selected as the research group, and Seventy-eight healthy elderly were selected as the control group. The levels of bone turnover marker(BTM) in serum of RA group and control group were measured, and the lumbar spine (L1-4) ,hip DXA and lumbar spine (L1-3) and hip QCT examination were analyzed and compared. Results ① The detection rate of osteoporosis in RA group by QCT was significantly higher than that in DXA.(P＜0.05).②Receiver operating characteristic(ROC) curve analysis showed that the area under the curve of QCT in the diagnosis of lumbar osteoporosis in RA group was 0.945, the sensitivity was 93.75%, and the specificity was 87.80%.③ The level of serum β-cross-linked C-telopeptide of type I collagen (β-CTX) was higher in RA patients than that in the control group, and the level of serum bone type I procollagen N-terminal peptide (PINP) was lower than that in the healthy control group, the difference was statistically significant (P＜0.05).④ In RA group, the bone mineral density (BMD) measured by lumbar QCT was negatively correlated with β-CTX（r=?0.81,P<0.05）and positively correlated with PINP（r=0.79,P<0.05）, while the BMD measured by lumbar DXA had no such correlation. Conclusion For elderly RA patients, the detection rate of osteoporosis in QCT is higher than that in DXA, with good sensitivity and specificity, and is related to BTM.

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