双能CT定量参数联合血清骨硬化蛋白、同型半胱氨酸水平对绝经后女性骨质疏松的诊断价值

Diagnostic value of dual-energy CT quantitative parameters combined with serum osteosclerosis protein and homocysteine levels in osteoporosis of postmenopausal women

目的:探讨双能CT定量参数联合血清骨硬化蛋白(SOST)、同型半胱氨酸(Hcy)水平对绝经后女性骨质疏松(OP)的诊断价值。方法:选择177例绝经后女性作为研究对象,分为OP组(92例)和非OP组(84例)。采用双源CT扫描研究对象的L1~L4腰椎,测量钙的CT值、钙浓度及脂肪分数。使用双能X线骨密度测量仪(DXA)对腰椎L1~L4的骨密度值(BMD)进行测定。采用酶联免疫吸附试验检测研究对象血清中的SOST蛋白表达水平,采用免疫测定法检测血清中Hcy的水平。结果:OP组与非OP组患者的年龄、体质量指数(BMI)、绝经年限和糖尿病史比较差异无统计学意义(P>0.05),OP组的BMD显著低于非OP组(P<0.05)。OP组钙的CT值及钙浓度显著低于非OP组(P<0.05),两组间的脂肪分数比较差异无统计学意义(P>0.05),OP组的血清SOST、Hcy水平显著高于非OP组(P<0.05)。钙的CT值、钙浓度与BMD间均呈显著正相关关系(P<0.001),血清SOST、Hcy水平与BMD间均呈显著负相关关系(P<0.001)。多因素二元Logistic回归分析结果显示,钙的CT值、钙浓度及血清SOST、Hcy水平是OP的独立相关因素(P<0.05)。ROC曲线分析结果显示,钙的CT值、钙浓度、血清SOST、Hcy水平独立诊断OP的敏感度和特异度分别为88.0%和71.4%、87.0%和72.6%、75.0%和76.2%,79.3%和73.8%,四者联合诊断OP的敏感度和特异度分别为90.2%和88.1%。结论:双能CT在绝经后女性OP的诊断中具有一定价值,采用血清SOST、Hcy水平作为辅助手段与双能CT联合使用有助于提升绝经后女性OP的诊断效能。

Objective:To investigate the diagnostic value of dual energy CT quantitative parameters combined with serum osteosclerosis protein(SOST)and homocysteine(Hcy)levels in osteoporosis(OP)of postmenopausal women.Methods:A total of 177 postmenopausal women were selected as the research subjects,and were divided into OP group(92 cases)and non-OP group(84 cases).The L1 to L4 lumbar vertebrae of the subjects were scanned by dual-source CT,and the CT value of calcium,calcium concentration and fat fraction were measured.Bone mineral density(BMD)of lumbar vertebra from L1 to L4 was measured by dual energy X-ray absorptiometry(DXA).Enzyme-linked immunosorbent assay(ELISA)was used to detect the expression of SOST in serum of the subjects,and immunoassay was used to detect the level of Hcy in serum of the subjects.Results:There were no significant differences in age,body mass index(BMI),years of menopause and diabetes history between the OP group and the non-OP group(P>0.05),and BMD in the OP group was significantly lower than that in the non-OP group(P<0.05).The CT value and concentration of calcium in the OP group were significantly lower than those in the non-OP group(P<0.05),and there was no significant difference in fat fraction between the two groups(P>0.05).The serum SOST and Hcy levels in the OP group were significantly higher than those in the non-OP group(P<0.05).The CT value of calcium and calcium concentration were significantly positively correlated with BMD(P<0.001),and the serum SOST and Hcy levels were significantly negatively correlated with BMD(P<0.001).Multivariate binary Logistic regression analysis showed that CT value of calcium,calcium concentration and serum SOST and Hcy levels were independent correlation factors of OP(P<0.05).ROC curve analysis showed that the sensitivity and specificity of CT value of calcium,calcium concentration,serum SOST level and serum Hcy level for the diagnosis of OP were 88.0%and 71.4%,87.0%and 72.6%,75.0%and 76.2%,79.3%and 73.8%,respectively,and the sensitivity and specificity of the combined diagnosis of OP were 90.2%and 88.1%,respectively.Conclusion:Dual-energy CT has certain value in the diagnosis of OP in postmenopausal women.The combination of serum SOST and Hcy levels and dual-energy CT is helpful to improve the diagnostic efficiency of OP in postmenopausal women.