小儿炎症性肠病定量CT骨密度测量的研究

A study of bone mineral density using quantitative computed tomography in children with inflammatory bowel disease

目的应用定量CT（QCT）评估小儿炎症性肠病（inflammatory bowel disease,IBD）的骨密度（bone mineral density,BMD）状况,为IBD的治疗提供依据。方法收集我院确诊的IBD患儿27例,同时收集正常人群62例。应用QCT方法测量两组人群骨密度,结果进行统计学分析。同时从中选取学龄儿童（7~12岁）的IBD患儿共12例作为病例组;按照性别、年龄、人数相匹配的原则从正常人群中选取12例作为正常对照组。对这两组的QCT结果进行统计学分析。并观察这两组对照结果的一致性。结果 1）0~14岁27名IBD患儿骨密度从110.9mg/cm3到201.8mg/cm3,骨密度平均值为（165.49±18.93）mg/cm3,与62名正常人群骨密度值的比较（IBD患儿低于正常人群骨密度的平均值（189.65±26.99）mg/cm3,Z=-4.07,P=0.000,P〈0.05,二者差异有统计学意义;2）克罗恩病（Crohn’s disease,CD）组患儿骨密度平均值（162.26±16.77）mg/cm3,与正常人群骨密度比较（CD组患儿低于正常人群骨密度的平均值（189.65±26.99）mg/cm3,Z=-3.261,P=0.001,P〈0.05,二者差异有统计学意义。溃疡性结肠炎（ulcerative colitis,UC）组患儿骨密度平均值（171.97±17.11）mg/cm3,与正常人群骨密度比较〔UC组患儿低于正常人群骨密度的平均值（189.65±26.99）mg/cm3〕,Z=-1.908,P=0.056,P〉0.05,二者差异无统计学意义;3）病例组（12名7~12岁IBD患儿）的骨密度与正常对照组（12名7~12岁正常儿童）骨密度的比较：病例组骨密度平均值为（159.9±15.32）mg/cm3,正常对照组骨密度平均值为（186.96±10.97）mg/cm3,t=-4.97,P=0.000,P〈0.05,二者差异有统计学意义,且病例组骨密度低于正常对照组的骨密度。结论 IBD患儿骨密度低于同年龄正常人群骨密度;其中CD组和UC组患儿骨密度均低于正常人群骨密度,且CD组患儿比UC组患儿更易出现骨密度下降。使用QCT骨密度测量技术可以精确敏感的评估患儿骨密度情况,指导临床进一步的治疗方案。

Objective To assess bone mineral density（ BMD） using quantitative computed tomography（ QCT） in children with inflammatory bowel disease（ IBD） in order to help the clinical treatment of IBD. Methods 27 children in our hospital diagnosed of IBD were retrospectively collected,and 62 normal children,all BMD using QCT in two groups were measured and statistically analyzed. 12 cases of IBD aged from 7 to12 years were selected as the study group compare to 12 normal children of the control group in accordance with the principle of gender,age,number of matches. QCT results of these two groups were statistically analyzed. Results 1） Bone mineral density of the 27 cases of IBD in children aged from 0 to 14 years old were from 110. 9mg / cm3 to 201. 8 mg / cm3,mean BMD was（ 165. 49 ± 18. 93） mg/cm3,compared with 62 normal people BMD values〔IBD in children less than the average of the normal population of BMD（ 189. 65 ± 26. 99） mg / cm3〕Z =-4. 07,P = 0. 000,P 0. 05,the difference was statistically significant; 2） BMD values of the CD group compared with the BMD of the normal population〔CD group less than the average of the normal population of BMD（ 189. 65 ± 26. 99） mg / cm3）,Z =-3. 261,P = 0. 001,P 0. 05,the difference was statistically significant,and BMD values of the UC group compared with the BMD of the normal population〔UC group less than the average of the normal population of BMD（ 189. 65 ± 26. 99） mg / cm3〕,Z =-1. 908,P = 0. 056,P 0. 05,the difference was not statistically significant; 3） BMD of the study group（ 12 children with IBD aged 7 ~ 12 years） compared with the BMD of the control group（ 12 healthy children aged 7 ~ 12 years） ： the mean BMD of the study group was（ 159. 9 ±15. 32） mg / cm3,the mean BMD of the control group was（ 186. 96 ± 10. 97） mg/cm3,t =-4. 97,P = 0. 000,the difference was statistically significant,so BMD of the study group was lower than the BMD of the control group. Conclusion The BMD of IBD in children was lower than the BMD of the normal population,the BMD of CD group and UC group was lower than the BMD of the normal population,and the BMD of CD group are more vulnerable to decline than the UC group. QCT BMD measurement techniques is a useful method to assess accurately the BMD of children and should be give some suggestion for clinical treatment.