定量CT测量髋关节骨密度的重复性与DXA测量的一致性

目的 探讨定量CT（QCT）髋关节骨密度（BMD）测量重复性及与双能X线骨密度测定仪（DXA）测量的一致性.方法 随机抽取28名（男10例,女18例）老年受试者（男性＞60岁,女性＞50岁）,并分别采用QCT与DXA测量髋关节骨密度.收集左侧髋关节QCT扫描CT原始数据,分别由3名操作者各测量1次,其中1名操作者在不同时间重复测量3次,用于评价QCT髋关节骨密度结果的重复性.比较QCT和DXA测量左侧髋关节骨密度结果.结果 3名不同操作者或同一操作者不同时间采用QCT测量28名受试者左侧髋关节的骨密度值之间具有很好的相关性（ICC：0.93～0.98,P＜0.01）,全髋骨密度值之间差异无统计学意义.DXA与QCT测量的股骨颈和全髋骨密度结果之间具有显著相关性（r=0.88,0.89,P＜0.01）,DXA测量的骨密度值较QCT相对应骨密度值大10.5%和9.7%（t=7.53,9.68,P＜0.01）.上述骨密度值系统误差可被校正.结论采用QCT测量髋关节BMD具有较好的重复性,其BMD值与DXA所测BMD结果具有相关性.QCT髋关节（CTXA）骨密度测量可用于骨质疏松症的诊断和疗效随访,具有临床应用前景.     

强直性脊柱炎患者骨密度随年龄的变化

目的 采用双能X线吸收法测量强直性脊柱炎患者(AS)不同部位的骨密度(BMD),探讨其与年龄变化的关系,为临床防治AS患者BMD降低提供参考.方法 选取门诊50例符合纽约诊断标准的AS患者,按年龄≤40岁、年龄＞ 40岁分为两组,分别检测其侧位腰椎(L1-L4)、股骨颈、髋关节BMD,以T值≤-1.0定义为BMD降低,包括骨量减少(-2.5＜T＜-1.0)与骨质疏松(T≤-2.5).结果 两组AS患者出现BMD降低的比例均高于正常人,且年龄＞ 40岁组其腰椎BMD减少的比例高于年龄≤40岁组(P＜0.05),而其腰椎平均T值低于年龄≤40岁组(P＜0.05),在股骨颈测得的BMD、骨质疏松比例两组无明显差异(P＞0.05).结论 AS患者早期即可出现骨量减少甚至骨质疏松,随着年龄的增长其侧位腰椎BMD降低明显,骨折风险增大.临床上应当提高对AS合并骨质疏松的警惕,及时予补钙等治疗,提高患者的生活质量.     

双源CT双能定量扫描测量骨密度的临床研究

目的 比较双源CT双能骨密度测量方法(DEQCT)与单能定量CT骨密度测量方法(SEQCT)测量正常成人腰椎骨密度的准确性.方法 应用自行设计开发的双源CT双能骨密度测量软件及临床上常用的SEQCT测量方法分别测量正常成年人腰椎骨密度,并将两种测量方法所测骨密度值进行比较.结果 DEQCT法所测各年龄组腰椎骨密度值变化与年龄明显相关,且均较SEQCT法测量值高,两者间均有显著性差异(P<0.05).结论 DEQCT测量法一定程度上弥补了目前临床上常用的测量方法的不足,能够为临床提供较SEQCT法更为精确的骨密度测量值.     

强直性脊柱炎患者骨质疏松分析

目的 研究强直性脊柱炎（AS）患者骨质疏松的发生及其相关因素。分析骨质疏松与骨代谢指标的关系。方法 对30例AS患者用双能X线吸收法（DEXA）测定腰椎和股骨颈骨密度（BMD），用酶联免疫法测定血清骨钙素（BGP），骨碱性磷酸酶（BAP）及尿脱氧吡啶胶原交联（D-Pyr)。结果 AS早期腰椎及股骨颈BMD均较对照组低，而晚期椎体周围软组织骨化使腰椎BMD增加，但股骨颈BMD仍低于对照组，30例AS患者中，骨质疏松6例，骨量减少10例，AS的股骨颈BMD与病程，血沉（ESR），C-反应蛋白（CRP）和X线分期呈负相关，绝经前女性BMD的变化不如男性明显，HLA-B27阳性与阴性患者BMD无明显差异。AS骨质疏松组，骨形成的指标（BGP，BAP）与对照组比较，差异无显著性，骨吸收的指标（D-Pyr)明显增高。结论 AS继发全身性骨质疏松不少见，其发生与病程，疾病活动性和疾病严重程度相关，AS骨质疏松主要与骨吸收增加有关。     

强直性脊柱炎患者肺部表现的高分辨CT特征及临床

目的研究强直性脊柱炎(anky losing spondy litis,A S)患者肺部高分辨CT(HRCT)表现及其临床特征。方法43例确诊A S患者分别进行肺HRCT、肺部X线平片、肺功能检查,并结合临床特征对比分析。结果43例A S患者中28例(65%)发现有肺HRCT异常,最常见的表现为非特异性间质改变20/43(46.5%),4例(9.3%)为间质性肺病(ILD),3例(7.0%)为上叶纤维化,每例患者可有1种以上病变表现。肺功能有16/43(23.3%)表现轻度限制性通气功能障碍,无DLCO下降。肺HRCT异常与不同病程、骶髂关节炎严重度、肺功能均无统计学相关。结论A S病人的肺部表现不少见,通过肺HRCT可以早期发现。     

骨密度定量超声与双能X线检测比较

<正>骨质疏松(OP)是一种以骨量降低和骨组织微结构破坏为特征,导致骨脆性增加和易于骨折的代谢性骨病〔1〕。临床上以性激素减少和年龄增加所致的生理退行性病变的原发性OP多见。本文就定量超声与双能X线骨密度(BMD)检测方法进行综述。1 OP流行及危害OP现已跃居世界常见病的第7位,而我国至少有6 944万OP患者。50岁以上人群患病率高达30.8%〔2〕。OP是一种难     

强直性脊柱炎髋关节异常的CT检查

目的：总结分析强直性脊柱炎(AS)髋关节异常在CT上的表现特点。方法：对21例有髋部症状的As病人进行了髋关节CT轴位3mm层厚连续扫描。结果:全部病例都出现髋关节间隙变窄，按放射学指数(BASR)-hip分级，69％(29／42)的关节有3、4级的较严重改变；其他改变有关节软骨下囊性变(90.5％)，股骨颈特征性的“衣领样”骨质增生改变、骨质疏松、关节囊肿胀等。结论:AS的髋关节异常在CT上有一定的特征性表现，结合同时有骶髂关节改变，可取得正确诊断。     

强直性脊柱炎骶髂关节病变的X线CT磁共振成像比较分析

强直性脊柱炎 (ankylosingspondylitis ,AS)为一种原因未明的以中轴骨、关节慢性炎症为主的全身性病变 ,属于风湿性疾病的范畴。在AS的骨关节病变中 ,骶髂关节是较早且几乎必受累及的部位 ,全面认识AS骶髂关节病变的影像学改变 ,对于AS的早期诊断具有重要意义。本文就 91例AS骶髂关节病变的X线平片、CT和磁共振成像 (MRI)影像学表现进行了分析和比较 ,同时初步探讨了AS骶髂关节病变的MRI早期影像诊断。1　资料与方法1 1　临床资料 :本组AS病例共 91例 ,男性 6 2例 ,女性 2 9例 ,年龄 17～ 37岁 ,平均 2 1 7岁 ;病程 5个月～ 9年 ,…     

CT在强直性脊柱炎的早期诊断和随访中的应用

目的；探讨ＣＴ检查在强直性脊柱炎（ＡＳ）的早期诊断和随访中的应用，方法；对临床拟诊或可疑ＡＳ病例双骶髂关节Ｘ线平片有ＣＴ检查，对未分类脊柱关节病和慢作用药治疗３年以上的ＡＳ病人进行ＣＴ随访，并结合临床，实验室资料进行分析，结果：Ⅲ级，Ⅳ级骶髂关节炎在Ｘ线平片和ＣＴ检查符合率较高，而Ⅲ级及Ⅱ级以下者差异较大。３０例未分类脊柱关节病经１０年以上随访，７例发展为ＡＳ，３１例治疗３年以上经ＣＴ随访者中，中     

强直性脊柱炎髋关节病变的影像学表现及评价

1993-2004年．我们对120例强直性脊柱炎（AS）累及髋关节的病变进行X线平片、CT、MRI分析,旨在提高对强直性脊柱炎髋关节病变的早期诊断。     

Osteoporosis in ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disorder, characterized by an inflammatory enthesopathy progressing to ossification and ankylosis. Osteoporosis is a well‐reported complication of AS. Bone loss begins early in the disease at the spine, and later progresses to the hip. This reduction in bone density leads to an increased risk of fractures. However, there is a lack of awareness regarding this common complication, thus adding to the morbidity associated with AS. Early recognition, appropriate assessment and timely treatment of this complication will help reduce the attendant fracture risk due to decreased bone mass.     

Effect of TNF-alpha inhibitor treatment on bone mineral density in patients with ankylosing spondylitis: A systematic review and meta-analysis

Objectives

Ankylosing spondylitis (AS) is a chronic inflammatory disease associated with an increased risk of osteoporosis and fractures. TNF inhibitors have been used to treat AS, but their effect on bone is unclear. Thus, we conducted a meta-analysis to study the effect of TNF inhibitors on spine and hip BMD in patients with AS.

Methods

Two authors independently searched MEDLINE and PubMed for longitudinal studies that had assessed the effect of TNF inhibitors on BMD in patients with AS. Studies with a minimum follow-up period of 1 year were included.

Results

Seven longitudinal studies and one randomized control trial were included, with a total of 568 AS patients (mean age range of 36–48 years and disease duration of 9–17 years). Lumbar spine BMD increased by 5.1% (95% CI: 4.0–6.1%, p = 0.00000) after 1 year of treatment with TNF inhibitors and by 8.6% (95% CI: 6.8–10.3%, p < 0.00001) after 2 years. Significant improvements in total hip BMD were also noted after 1 [1.8% (1.0–2.5%)] and 2 years [2.5% (1.9–3.0%)]. Compared to baseline, femoral neck BMD remained stable after 1 year [0.7% (−0.8% to 2.2%), p = 0.34]. No significant heterogeneity was noted amongst the included studies.

Conclusions

TNF inhibitors can increase lumbar spine and total hip BMD and maintain femoral neck BMD for up to 2 years in patients with AS. More research is needed to assess the effect of TNF inhibitors on bone quality and fracture risk.     

Bone mineral density and bone remodelling in Tunisian patients with ankylosing spondylitis: A cross-sectional study

Aim of the workTo assess the bone turnover markers and bone mineral density (BMD) in ankylosing spondylitis (AS) patients and to evaluate their association with clinical variables.Patients and methodsForty-seven AS patients were compared with 47 matched control. Clinical features and inflammatory parameters were assessed. C-terminal telopeptide fragments of type I collagen (CTX), alkaline phosphatases (ALP), N-terminal propeptide of type I procollagen (PINP) serum levels, and BMD of the lumbar spine and femoral neck were evaluated. The Bath AS disease activity and functional indices (BASDAI and BASFI) were assessed.ResultsMean serum levels of C-reactive protein, ALP and CTX were higher in AS patients than control (p = 0.001, p = 0.001 and p = 0.027 respectively). Osteopenia and osteoporosis were significantly more frequent in AS patients (57.4%) than control (21.3%) (p < 0.001). The PINP and ALP significantly correlated with disease duration (r = 0.33, p = 0.02 and r = 0.3, p = 0.04 respectively). BMD of the femoral neck was significantly lower in AS patients with history of coxitis than AS patients without (p = 0.02). Patients on anti-tumour necrosis factor (TNFα) therapy had higher T score (lumbar spine) compared to those not. Multivariate regression showed that CRP levels and disease activity were independently associated with low BMD and T score (lumbar) was significantly associated with anti-TNF use (p = 0.007).ConclusionsAn increase in bone turnover markers and decrease of BMD were observed in AS patients. Inflammatory activity of AS was associated to hyper bone remodelling and decrease of BMD. Anti-TNF use seems to be beneficial on AS inflammation and therefore on the BMD.     

Bone mineral density in young males with ankylosing spondylitis

Objective: To assess bone mineral density (BMD) abnormalities in young Indian males with ankylosing spondylitis (AS) and factors influencing this. Methods: Eighty AS male subjects were compared with 160 age/sex matched controls for BMD of lumbar spine and proximal femur. AS subjects were evaluated and followed up every 3 months for disease activity. BMD was estimated at spine and proximal femur using the dual‐energy X‐ray absorptiometry (DXA) technique. Results: All subjects were males with mean age of 32.9 ± 8.3 years and mean duration of disease was 8.1 ± 5.8 years. AS subjects had significantly lower BMD at the spine and femur as compared with controls (both P < 0.001). Using WHO standards, osteoporosis (OP) in spine and femur neck was seen in 28.75% (controls: 1.84%, P < 0.001) and 11.54% (controls: 1.23%, P < 0.001), respectively. No statistically significant difference in prevalence of OP was seen with disease duration, C‐reactive protein levels and disease activity indices (all P > 0.05). Syndesmophytes were seen in 22.5% (n = 18) of AS subjects. There was no significant difference between BMD values at spine in AS subjects with or without syndesmophytes (0.91 + 0.16 g/cm²vs. 0.90 + 0.14 g/cm², P = 0.79). Conclusion: OP is a significant complication in AS even in young males with early disease, and more prevalent in the spine compared to femur. In our study, BMD was not influenced by disease activity indices, inflammatory markers or total disease duration. Spinal BMD is the most sensitive site for defining OP in AS.     

Quantitative ultrasound is better correlated with bone mineral density and biochemical bone markers in elderly women

The association between quantitative ultrasound (QUS) and bone turnover in postmenopausal women of different ages is an area of continuous investigation. The aim of this study was to investigate the relationship of ultrasound parameters [broadband ultrasound attenuation (BUA) and speed of sound (SOS)] to bone mineral density (BMD) and biochemical markers of bone turnover in three age groups of postmenopausal women. One hundred and twenty-three postmenopausal Caucasian women were divided into three groups according to their age: group A, range 44–54 years, mean age (±SD) 48.3 ± 2.3; group B, range 55–65 years, mean age 59.4 ± 2.1; and group C, range 66–77 years, mean age 68.2 ± 3.1. Ultrasound parameters were measured by the DTU-one imaging ultrasonometer in the calcaneus. BMD was assessed by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine, femoral neck, and trochanter. Bone turnover was assessed by serum bone-specific alkaline phosphatase (BAP), urinary excretion of free deoxypyridinoline, N-telopeptides (NTX), and C-telopeptide breakdown products of type I collagen (CTX). QUS and BMD were significantly correlated in all sites, except hip BMD in group A. The most significant correlation was observed between BUA and femoral neck BMD in group C (r = 0.626, p < 0.01). BUA correlated significantly with BAP, NTX, and CTX (r = −0.434, −0.511, −0.478, respectively; p < 0.01), and SOS with BAP and NTX (r = −0.351 and −0.356, respectively; p < 0.05) only in group C. In groups A and B, ultrasound parameters did not correlate significantly to biochemical markers. Ultrasound parameters were better correlated to hip BMD and to biochemical markers of bone turnover in elderly postmenopausal women. These ultrasound measurements could be used as a screening test for bone status, either in nonambulatory third aged women or in those living in rural areas where attending medical centers with DEXA equipment and biochemical laboratories is difficult.     

阿仑膦酸钠对全髋关节置换术后髋臼周围骨密度的影响

目的探讨阿仑膦酸钠对全髋关节置换术后髋臼周围骨密度的影响。方法将符合全髋置换纳入标准的患者随机分成阿仑膦酸钠组与对照组,阿仑膦酸钠组术后除常规治疗外尚服用阿仑膦酸钠,对照组仅常规治疗。2组患者均应用骨密度测量仪（DEXA）分别于术后第6天、3、6个月测定髋臼各个分区的骨密度。结果获得完整随访病例共58例,术后3、6个月各区骨密度均呈持续下降趋势,和对照组相比,术后3个月阿仑膦酸钠组髋臼假体周围骨量（Ⅲ区）的差异有统计学意义（P〈0．01）,其余各测量区骨密度2组相比差异无统计学意义（P〉0．05）。与对照组相比,术后6个月阿仑膦酸钠组髋臼假体周围骨量（Ⅲ区）的差异有统计学意义（P〈0．01）,其余各测量区2组相比差异无统计学意义（P〉0．05）。结论阿仑膦酸钠能有效防止髋臼假体周围骨量减少。     

Inflammation on spinal magnetic resonance imaging is associated with poor bone quality in patients with ankylosing spondylitis

Abstract

Objective: To determine the association between inflammatory lesions on spinal magnetic resonance imaging (MRI) and trabecular bone score (TBS) in patients with ankylosing spondylitis (AS).

Methods: Ninety-seven patients with AS underwent spine MRI and dual energy X-ray absorptiometry of the lumbar spine to measure TBS and bone mineral density (BMD). Bone marrow edema (BME) on MRI was considered an inflammatory lesion. The presence, depth (>1?cm), and intensity of BME on MRI were scored for the 1st–4th lumbar spine segments. Inflammatory markers and spinal structural damage scores at the time of MRI examination were recorded. The association between inflammatory activity score on MRI and TBS was evaluated.

Results: Among the 97 patients, 52 had BME on spinal MRI (L1–L4). The mean TBS values were 1.38?±?0.11 and 1.43?±?0.11 for patients with and without BME, respectively (p?=?.022). Total inflammatory activity scores on spinal MRI correlated negatively with TBS, but not with BMD. Patients with a TBS value representing a high fracture risk had more deep BME (>1?cm) (p?=?.048) on MRI. After adjustment for age, symptom duration, and lumbar spinal structural damage, the TBS decreased as inflammation severity on MRI increased (p?=?.026).

Discussion: In AS patients, inflammation on spinal MRI was negatively correlated with TBS. The severity of local bone inflammation in the spine was associated with poor bone quality. These findings suggest that the control of active bone inflammation may be effective for preventing osteoporosis in AS patients.     

男性HIV相关脂肪营养不良综合征患者骨矿含量DXA测量结果浅析

目的分析HIV相关脂肪营养不良综合征患者的骨矿量(BMC)及骨密度(BMD)变化特点。方法 2002年1月至2009年12月在北京协和医院接受抗逆转录病毒治疗(HAART)治疗并行双能X线骨密度测量(DXA)检查的成年男性HIV/AIDS患者41例,年龄20～71岁,平均年龄(43±11)岁。根据患者主诉和医师评估结果,将上述患者分为脂肪营养不良(LD)组与非LD组,分析2组患者骨矿量及骨密度的差异。结果 41例HIV/AIDS患者中,经调整年龄、身高、体重,BMC与脂肪量(FM)间呈正向线性回归关系;LD组患者全身和局部骨BMC均低于非LD组患者,2组患者腰椎BMC差异有统计学意义(P=0.038);LD组患者腰椎和右髋部BMD均低于非LD组患者,2组患者腰椎BMD差异有统计学意义(P=0.028)。结论 DXA对评估HIV-LD患者的骨矿量变化有重要意义,可为骨质疏松的综合预防提供客观依据。