定量CT对强直性脊柱炎早期骨量丢失的诊断价值

Diagnostic Value of CT in Early Bone Loss of Ankylosing Spondylitis

目的探讨CT对强直性脊柱炎(AS)患者早期髋关节骨量丢失的诊断价值。方法选取2019年2月至2021年8月收治的早期AS患者102例为观察组,另选取健康者100例为对照组,两组均进行定量CT检查。比较分析两组股骨颈、股骨粗隆、粗隆间以及全髋关节的皮质骨、松质骨、全骨的骨密度(BMD),采用ROC曲线分析其预测早期AS的价值结果观察组髋关节构成骨的皮质骨、全骨BMD值小于对照组(P<0.05),两组松质骨BMD值无明显差异(P>0.05);ROC分析显示,全髋关节皮质骨BMD(AUC=0.664)、全骨BMD(AUC=0.658)是预测早期AS的重要因素(P<0.05);相关分析显示,AS患者全髋关节皮质骨BMD值与BMI呈正相关(r=303,P=0.002);全髋关节松质骨BMD值与BMI呈正相关(r=0.497,P<0.001),与年龄呈负相关(r=-0.368,P<0.001);全髋关节全骨BMD值与BMI呈正相关(r=0.371,P<0.001)。结论早期AS患者髋关节皮质骨的骨量丢失可能早于松质骨。

Objective To evaluate the value of CT in the diagnosis of early hip joint bone loss in patients with ankylosing spondylitis(AS).Methods 102 cases of early AS patients admitted from Feb 2019 to Aug 2021 were selected as the observation group,and 100 cases of healthy people were selected as the control group.Quantitative CT examination was performed in both groups.The bone mineral density(BMD)of cortical bone,cancellous bone and total bone of femoral neck,femoral trochanter,intertrochanter,whole hip joint,and ROC curve was used to analyze its value of predicting early AS.Results:The BMD value of cortical bone and total bone of hip joint in the observation group were lower than those in the control group(P<0.05),but there was no significant difference in the BMD value of cancellous bone between the two groups(P>0.05).ROC analysis showed that BMD of cortical bone of hip joint(AUC=0.664),BMD of total bone of hip joint(AUC=658)were important factors in predicting early AS(P<0.05),Correlation analysis showed that BMD of cortical bone of hip joint was positively correlated with BMI in AS patients(r=303,P=0.002).BMD of spongiosa of hip joint was positively correlated with BMI(r=0.497,P<0.001),and negatively correlated with age(r=-0.368,P<0.001).BMD of total bone of hip joint was positively correlated with BMI(r=0.371,P<0.001).Conclusion In patients with early AS,the bone loss in cortical bone of the hip joint may be earlier than that in spongiosa.