活动期类风湿关节炎患者单光子发射计算机断层关节显像与骨代谢标志物的相关性研究

The correlations of single photon emission computed tomography joints scan and bone metabolic markers in active rheumatoid arthritis

目的 探讨类风湿关节炎（RA）活动期患者单光子发射计算机断层显像（SPECT）关节显像定量值与血清骨代谢标志物的相关性.方法 收集2013年5月至2014年12月山西医科大学第二医院风湿科初诊活动期RA患者60例,均于治疗前行血清骨标志物Ⅰ型胶原C末端肽（CTX-Ⅰ）、Ⅰ型前胶原氨基端前肽（PINP）水平检测,及SPECT全身骨显像和靶关节局部断层骨显像,计算SPECT关节显像定量值.结果 RA患者SPECT关节显像定量值为6.48±1.98,CTX-Ⅰ水平为（0.66±0.37） mg/L,PINP水平为（46.35 ±28.15） mg/L,高于对照组[3.73±1.16;（0.58±0.21）mg/L;（30.47±13.75） mg/L;P值均＜0.01].SPECT关节显像定量值与RA病程6～ 24个月者CTX-Ⅰ、病程≤6个月者CTX-Ⅰ、病程6～ 24个月者PINP呈正相关（r值分别为0.513、0.495、0.402,P值均＜0.05）,与病程≤6个月者PINP无相关性（r=0.336,P=0.081）.结论 活动期RA患者SPECT关节显像定量值与骨代谢标志物呈正相关,可以辅助临床诊断活动期RA,以尽早干预和控制骨侵蚀发展.

Objective To explore the correlation between quantitative value of joint bone scan by single photon emission computed tomography （SPECT） and serum bone metabolic markers in patients with active rheumatoid arthritis （RA）.Method Clinical data of 60 newly diagnosed RA patients were retrospectively collected in Department of Rheumatology and Immunology from May 2013 to December 2014,including 28 cases with medical history less than 6 months and 32 from 6 months to 2 years.Serum Cterminal telopeptide of type Ⅰ collgen（CTX-Ⅰ）and N-terminal propeptide of type Ⅰ collagen（PINP） were tested by chemiluminesence.SPECT whole body bone and target joint scan before treatment was done.Thirty-nine healthy subjects as control group received ultrasound,electrocardiogram,X-ray,and whole body bone imaging examination.Quantitative values of joint imaging were calculated for the statistical analysis.Result Demographic data between RA group and control group were comparable （P 〉 0.05）,including sample,sex,age and BMI.The joint SPECT value,CTX-Ⅰ and PINP levels were all significantly higher than those of control group （P 〈 0.01）,which were 6.48 ± 1.98 versus 3.73 ± 1.t6;（0.66 ± 0.37） mg/L versus （0.58 ±0.21） mg/L;（46.35 ±28.15） mg/L versus （30.47 ± 13.75） mg/L respectively.Joint SPECT values had positive correlations with serum CTX-Ⅰ levels in all RA patients,as well as PINP in patients with disease duration 6mon-2years.And the according correlation coefficients were 0.513,0.495,0.402 （P 〈 0.05）.But SPECT value had no correlation with CTX-Ⅰ （P =0.081） in patients with disease duration less than 6 mon.The correlation coefficient was 0.336.Conclusion SPECT imaging quantitative values were positively correlated with serum bone metabolic parameters.Thus SPECT imaging alone or combined with bone markers are helpful in diagnosing active RA.