T1 mapping与R2* maps联合诊断慢性肾病

目的 观察T1 mapping与R2^* maps联合诊断慢性肾病(CKD)的价值。方法 纳入27例CKD患者,根据改善全球肾脏病预后组织CKD分期标准将其分为A组(轻度肾损害,n=16)和B组(中重度肾损害,n=11),另纳入20名健康成年人作为对照组(C组);观察其肾脏T2WI、T1 mapping及R2^* maps,比较3组间整体及两两间右肾皮、髓质T1值和R2^*值差异,行logistic回归分析,评估右肾皮髓质T1值、R2^*值和二者联合诊断CKD的效能。结果 3组间右肾皮质T1值及R2^*值整体差异均有统计学意义(P均＜0.05),而髓质T1值及R2^*值差异均无统计学意义(P均＞0.05);B组皮质T1值显著高于A组和C组(P均＜0.05),A组皮质R2^*值显著高于B组和C组(P均＜0.05)。以右肾皮质T1值鉴别CKD轻度与中重度肾损害的曲线下面积(AUC)为0.77,鉴别CKD中重度肾损害与健康人的AUC为0.90;皮质R2^*值鉴别CKD轻度与中重度肾损害的AUC为0.94,鉴别CKD轻度肾损害与健康人的AUC为0.88;皮质T1值与R2^*值联合鉴别轻度CKD肾损害与中重度肾损害的AUC为0.97,与右肾皮质T1值的AUC差异有统计学意义(Z=2.14,P=0.033)。结论 T1 mapping与R2^* maps联合有助于诊断CKD。     

定量CT测量T12骨密度替代病变腰椎用于骨质疏松诊断的可行性

目的 探讨在低剂量CT肺癌筛查联合定量CT骨密度检查中,以测量T12椎体骨密度替代病变的L1或L2用于骨质疏松诊断的可行性。方法 选取1 298名接受低剂量CT肺癌筛查联合定量CT骨密度检查的健康体检者,测量其T12、L1、L2椎体骨密度,并计算校准的T12骨密度,记为T12^*。以L1+L2为诊断标准,分别分析各椎体组合T12+L1、T12+L2、T12^*+L1、T12^*+L2与L1+L2评估骨量的一致性和诊断骨质疏松的差异性。结果 各椎体组合与L1+L2评估骨量的一致性均较好（Kappa均>0.75,P均<0.05）。各椎体组合诊断骨质疏松的特异度均>98%。T12+L1、T12+L2诊断骨质疏松的敏感度分别为73.33%（143/195）及77.95%（152/195）;而T12^*+L1、T12^*+L2诊断骨质疏松的敏感度分别为83.08%（162/195）及90.26%（176/195）。结论 定量CT测量T12骨密度替代病变L1或L2,可能降低诊断骨质疏松的敏感度,应对其进行校准。     

心脏MR T2* mapping技术定量评价2型糖尿病患者左心室心肌改变

目的 探讨心脏MR T2^* mapping技术定量评价2型糖尿病（T2DM）患者心肌改变的临床价值。方法 对54例T2DM患者（T2DM组）及43名健康志愿者（正常对照组）采用T2^* mapping技术行心脏MR检查。测量并比较2组间左心室各节段心肌及各支冠状动脉供血区心肌T2^*值的差异。结果 T2DM组左心室第6、15、16节段T2^*值低于正常对照组（P均<0.05）,2组间其余各节段心肌T2^*值差异均无统计学意义（P均>0.05）。T2DM组冠状动脉左回旋支（LCX）供血区心肌T2^*值低于正常对照组（P=0.035）,2组间左前降支（LAD）及右冠状动脉（RCA）供血区心肌T2^*值差异均无统计学意义（P均>0.05）。结论 T2^* mapping技术可用于定量评价T2DM患者左心室心肌改变,有助于早期发现糖尿病心肌病。     

大鼠阿尔茨海默病模型的T2map成像研究

研究背景 临床研究均表明影像学检查对阿尔茨海默病(AD)的诊断具有一定价值,但缺乏病理及病理生理学的验证,进而对一些研究成果不能深入地分析。而且以患者为研究对象的研究通常始于疾病的较晚期阶段,这样不容易反映AD发生、发展的动态过程,更不能早期发现AD。目的 采用双侧颈总动脉结扎联合高Cu²⁺ 喂养法诱导痴呆模型鼠的行为学和病理学改变;使用临床型1.5T MR活体对模型鼠脑行T2^* WI、并使用T2map对不同脑区进行定量分析,以评价MR活体评价痴呆病理变化的可行性。方法 随机选择SD大鼠60只,分为两组:实验组(36只):给予双侧颈动脉结扎加饮用水给予高Cu²⁺ 喂养(3个月后停止,给予正常饮用水),术中6只死亡;对照组(24只):仅分离双侧颈总动脉但不予结扎。分别于术后3、6、9个月(实验组取10只、对照组取8只)进行Morris测试评价行为学改变,然后对大鼠大脑行T2*WI,使用T2map进行大鼠大脑不同脑区的T2弛豫时间定量分析。处死大鼠,进行相关病理学研究(HE染色、银染、Aβ免疫组织化学染色、铁染色、ThioflavineS染色)。两组大鼠不同时间点的平均逃避潜伏时间和T2弛豫时间比较用两因素重复测量资料的方差分析。结果 通过永久性双侧颈总动脉结扎联合高Cu²⁺ 法建立了一种新的复合型痴呆模型。Morris水迷宫实验发现术后3、6、9个月,实验组平均逃避潜伏时间较对照组明显延长(P<0.01),说明与对照组相比出现记忆学习能力缺陷。术后6个月,实验组大鼠出现了类似老年斑的结构,皮质和海马区出现Aβ免疫反应阳性细胞,ThioflavineS染色、铁染色、银染都有阳性发现。术后6、9个月实验组的皮质和海马区的T2弛豫时间明显减低,与对照组比较,差异有统计学意义,实验组海马、颞叶、顶叶皮质的T2弛豫时间随着年龄的增长,呈下降趋势,差异有统计学意义。而纹状体、丘脑、胼胝体等脑区未见明显差别。结论 双侧颈动脉结扎联合高Cu²⁺ 喂养法致AD 大鼠模型可模拟出AD 相关的行为学改变,而且亦出现类似人类AD的神经病理学及病理生理学改变。铜的引入,可能通过多种机制加速AD的病理进程。使用临床1.5T MR对这种模型进行活体影像评价是可行的,该模型大鼠早期海马及皮质的T2弛豫时间的减低可能提示AD的病理进程。     

骨样骨瘤99Tcm-MDP SPECT/CT特征

目的 观察骨样骨瘤的⁹⁹Tc^m-MDP SPECT/CT特征。方法 对36例临床疑诊骨样骨瘤患者行⁹⁹Tc^m-MDP SPECT/CT显像,分析其特征;以手术病理或影像学随访结果为诊断标准,评价SPECT/CT显像对骨样骨瘤的诊断价值。结果 36例中,最终确诊28例骨样骨瘤。⁹⁹Tc^m-MDP SPECT/CT诊断骨样骨瘤28例、其他疾病8例,诊断敏感度、特异度和准确率均为100%。28例骨样骨瘤中,骨皮质型8例（8/28,28.57%）,骨膜下型4例（4/28,14.29%）,松质骨型16例（16/28,57.14%）;17例（17/28,60.71%）病变位于关节囊内,11例（11/28,39.29%）位于关节囊外;⁹⁹Tc^m-MDP SPECT/CT显像均可见双密度征,瘤巢显像剂摄取明显高于周围骨质硬化,并逐渐递减。结论 骨样骨瘤的⁹⁹Tc^m-MDP SPECT/CT表现具有一定特征性,可为诊断及鉴别诊断提供信息。     

超短回波时间磁共振（UTE-MRI）在骨皮质成像中的应用

随着社会老龄化的进展,骨质疏松患病率不断增高,作为骨质疏松最严重的并发症之一,骨质疏松骨折极大地降低了患者的生活质量,并带来沉重的社会经济负担。近年来,骨皮质在骨质疏松骨折中的重要作用越来越受到研究者的重视。相较于传统影像学方法,磁共振超短回波时间脉冲序列能够对骨皮质进行在体的定性定量研究,包括骨折等疾病观察、骨皮质T1、T2*时间测定、水定量、孔隙度测定、矿质含量测定、骨皮质灌注研究等,对骨皮质在骨质疏松等疾病中的改变可进行全面的评估,具有良好的临床应用前景。本文将对超短回波时间磁共振序列进行介绍,并着重对其在骨皮质成像中的研究进展进行综述。     

BOLD-MRI评价2型糖尿病患者降血糖治疗前后肾组织氧合状况

目的 采用BOLD-MRI评价糖尿病患者降血糖治疗前后肾组织氧合水平改变情况及其与血糖水平的相关性。方法 对23例2型糖尿病患者（糖尿病组）于降血糖治疗前后及23名健康志愿者（对照组）行肾脏BOLD-MRI,测量肾脏皮、髓质R2^*值,并进行统计学分析。结果 糖尿病组降血糖前、降血糖后及对照组肾皮质的R2^*值均低于肾髓质（P均<0.001）。糖尿病组降血糖前肾髓质R2^*值高于降血糖后和对照组（P均=0.001）,降血糖后肾髓质R2^*值与对照组差异无统计学意义（P=0.941）。糖尿病组降血糖前、降血糖后、对照组间肾皮质R2^*值差异无统计学意义（P=0.572）。糖尿病组肾髓质R2^*值与血糖值呈正相关（r=0.365,P=0.002）,而肾皮质R2^*值与血糖值无明显相关性（r=-0.014,P=0.908）。结论 降血糖治疗可以改善肾髓质的氧合状况;BOLD-MRI可用于评价糖尿病患者降血糖治疗前后肾组织氧含量的变化。     

扩散加权成像对前列腺外周带炎症和肿瘤T2低信号的鉴别作用

目的 通过磁共振DWI探讨前列腺炎和前列腺癌患者前列腺外周带T2低信号区ADC值的变化特点,定量评价DWI在鉴别前列腺外周带T2低信号区炎症和肿瘤中的价值。方法 收集103例MRI显示为前列腺外周带T2信号减低的初诊患者,根据超声引导下穿刺活检结果分为前列腺炎组(50例)和前列腺癌组(53例),测定T2低信号区的平均ADC值和最低ADC值;采用独立样本t检验对两组ADC值进行比较。结果 前列腺炎组平均ADC值为(1.33±0.20)×10^－3 mm²/s,前列腺癌组平均ADC值为(0.86±0.12)×10^－3 mm²/s,差异有统计学意义(t=14.70,P＜0.05)。前列腺炎组最低ADC值为(1.22±0.19)×10^－3 mm²/s,前列腺癌组最低ADC值为(0.68±0.15)×10^－3 mm²/s(t=16.45,P＜0.05)。结论 应用DWI定量评价和鉴别外周带T2低信号前列腺炎和前列腺癌是可行的。     

MR T2* mapping定量评估膝关节前交叉韧带重建术后移植物成熟度

目的 探讨MR T2^* mapping定量评估膝关节前交叉韧带重建（ACLR）术后移植物成熟度的临床价值。方法 对26例因前交叉韧带（ACL）损伤而接受ACLR患者（ACLR组）分别于术后1、3、6个月行膝关节三维稳态采集快速成像（3D-FIESTA）及T2^* mapping检查,另对26名健康成人志愿者（对照组）行单次膝关节同序列扫描。对ACLR组于术后6个月以统一国际膝关节文献委员会膝关节评估表（IKDC）进行临床功能评分;比较ACLR组术后各时间点移植物T2^*值及其与对照组ACL的T2^*值的差异,分析ACLR组术后6个月移植物T2^*值与IKDC评分的相关性。结果 ACLR组术后1、3个月移植物T2^*值低于对照组ACL的T2^*值;ACLR组术后6个月移植物T2^*值高于术后1、3个月（P均<0.01）;ACLR组术后6个月移植物与对照组ACL的T2^*值、ACLR组术后1与3个月移植物T2^*值差异均无统计学意义（P均>0.05）。ACLR组术后6个月移植物T2^*值与IKDC评分呈中度负相关（r=-0.525,P=0.008）。结论 MR T2^* mapping对无创定量评估ACLR术后移植物成熟度具有一定价值。     

核素肾动态显像当日再进行骨显像的可行性

目的 观察肾动态显像当日进行全身骨显像对骨显像图像质量及患者的安全性的影响。方法 选取检查申请中既有肾动态显像又有全身骨显像检查的成年患者53例为观察组,常规接受⁹⁹Tc^m-DTPA肾动态显像检查2 h后,再注射⁹⁹Tc^m-MDP,按骨显像流程接受全身检查;另选取53例仅接受骨显像检查患者为对照组。两组于注射⁹⁹Tc^m-MDP后即刻、30 min、1 h、2 h、4 h、6 h、24 h观察患者不良反应。观察两组患者骨显像图像质量,统计图像质量优良率。测量骨后位像T12、L4、髂嵴、肱骨中段、股骨中段和髂骨上2 cm处软组织的放射计数,计算各部位靶/非靶比值（T/NT）值;对两组数据进行统计学分析。结果 两组患者均无不良反应。观察组和对照组肉眼观察图像质量优良率为90.57%（48/53）、92.45%（49/53）,差异无统计学意义（χ²=0.12,P > 0.05）。两组间T12、L4、肱骨中段、股骨中段T/NT值差异均无统计学意义（P均> 0.05）,髂嵴T/NT值差异有统计学意义（t=3.45,P<0.05）。结论 核素肾动态显像检查同日行全身骨显像检查对图像质量无明显影响。     

2型糖尿病女性患者骨密度与骨转换率的相关性

目的探讨2型糖尿病(T2DM)女性患者骨密度与骨转换及骨重建的相关性。方法回顾性分析纳入在南方医科大学第三附属医院内分泌科住院的201例T2DM女性患者住院期间的临床数据,采用双能X线骨密度仪,测量骨密度,包括腰椎、左侧股骨颈和髋部总体,将纳入对象分为骨量正常组85例(T>-1)、骨量减少组87例(-2.5 < T < -1)和骨质疏松组29例(T < -2.5),检测骨钙素N端中分子片段和β-Ⅰ型胶原C-末端交联分别评估骨形成和骨吸收。根据骨形成和骨吸收的T值分别计算骨转换率和骨重建率,比较T2DM患者骨质疏松组和骨量正常组患者的的骨转换率T值以及骨重建率T值的差异,并评估T2DM女性患者骨转换率T值和骨重建率T值与骨密度之间的相关性。结果T2DM女性患者骨质疏松组的骨转换率T值与T2DM女性患者骨量正常组的骨转换率T值差异有统计学意义(P=0.041),T2DM女性患者骨转换率T值与髋部骨密度负相关(r=-0.14,P =0.049)。校正糖化血红蛋白后,T2DM女性患者骨转换T值与髋部仍呈骨密度负相关(r=-0.144,P=0.043)。结论在T2DM女性患者中,随着骨转换率的增高,患者骨密度越低,并发低创伤性骨折的风险也会随之增高。      

Prevalence of Morphometric Vertebral Fractures in Patients With Type 1 Diabetes

OBJECTIVE

Several studies showed low bone mineral density (BMD) and elevated risk of symptomatic fractures in patients with type 1 diabetes (T1D). To our knowledge, there has been no investigation on the prevalence of asymptomatic vertebral fractures (VFx) in T1D. In the current study, we assessed BMD and the prevalence of VFx in T1D.

RESEARCH DESIGN AND METHODS

We evaluated 82 T1D patients (26 males and 56 females, aged 31.1 ± 8.6 years, BMI 23.5 ± 3.3 kg/m², disease duration 12.8 ± 8.3 years) and 82 controls (22 females and 60 males, aged 32.9 ± 5.8 years, BMI 23.9 ± 4.8 kg/m²). Spinal and femoral BMD (as Z-score, Z-LS and Z-FN, respectively) and the prevalence of VFx were evaluated by dual X-ray absorptiometry.

RESULTS

T1D patients had lower Z-LS and Z-FN than controls (−0.55 ± 1.3 vs. 0.35 ± 1.0, P < 0.0001, and −0.64 ± 1.1 vs. 0.29 ± 0.9, P < 0.0001, respectively) and a higher prevalence of VFx (24.4 vs. 6.1%, P = 0.002). Age, diabetes duration, age at diabetes manifestation, glycosylated hemoglobin, Z-LS, Z-FN, and the prevalence of chronic complications were similar for patients with and without VFx. In the logistic regression analysis, the presence of VFx was associated with the presence of T1D but not with lumbar spine BMD. Whereas moderate or severe VFx was associated with low lumbar spine BMD in the whole combined group of T1D patients and controls, there was no association between moderate or severe VFx and lumbar spine BMD in the T1D group.

CONCLUSIONS

T1D patients have low BMD and elevated prevalence of asymptomatic VFx, which is associated with the presence of T1D independently of BMD.Type 1 diabetes (T1D) has been suggested to be associated with an increased risk of fractures (1). The exact mechanisms accounting for bone fragility in T1D are not known in detail (2,3). In most but not all studies, bone mineral density (BMD), as measured by dual X-ray absorbtiometry (DXA), appears to be reduced (1–3). In particular, in adults, who have reached the peak of bone mass, the findings are somewhat heterogeneous, although most studies point toward a negative effect of T1D on BMD (2,4). In keeping with this, combined study analysis estimated that T1D increases the risk of clinical fractures by 1- to 2-fold at the spine, 1.5- to 2.5-fold at the hip, and 2-fold at the distal radius (2). No data are available regarding the risk of asymptomatic morphometric vertebral fracture (VFx) in T1D patients. This is an important lack of knowledge, because it is known that the presence of a morphometric VFx increases the risk of a subsequent spinal or hip fracture, regardless of BMD (5). In addition, a recent meta-analysis demonstrated an absolute risk of hip fracture in T1D higher than that expected on the basis of BMD variation (1). This suggests that in T1D the reduction of BMD estimates the fracture risk only partially. In this study, we evaluated the BMD and the prevalence of morphometric VFx in a group of adult T1D patients.     

Integrating real‐world data and modeling to project changes in femoral neck bone mineral density and fracture risk in premenopausal women

Decline of bone mineral density (BMD) during menopause is related to increased risk of fractures in postmenopausal women, however, this relationship in premenopausal women has not been established. To quantify this relationship, real‐world data (RWD) from the National Health and Nutrition Examination Survey (NHANES), and longitudinal data from the elagolix phase III clinical trials were modeled across a wide age range, and covariates were evaluated. The natural changes in femoral neck BMD (FN‐BMD) were well‐described by a bi‐exponential relationship with first‐order BMD formation (k₁) and resorption (k₂) rate constants. Body mass index (BMI) and race (i.e., Black) were significant predictors indicating that patients with high BMI or Black race experience a relatively lower BMD loss. Simulations suggest that untreated premenopausal women with uterine fibroids (UFs) from elagolix phase III clinical trials (median age 43 years [minimum 25–maximum 53]) lose 0.6% FN‐BMD each year up to menopausal age. For clinical relevance, the epidemiological FRAX model was informed by the simulation results to predict the 10‐year risk of major osteoporotic fracture (MOF). Premenopausal women with UFs, who received placebo only in the elagolix phase III trials, have a projected FN‐BMD of 0.975 g/cm² at menopause, associated with a 10‐year risk of MOF of 2.3%. Integration of modeling, RWD, and clinical trials data provides a quantitative framework for projecting long‐term postmenopausal risk of fractures, based on natural history of BMD changes in premenopausal women. This framework enables quantitative evaluation of the future risk of MOF for women receiving medical therapies (i.e., GnRH modulators) that adversely affect BMD.

Study Highlights

• WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC?

Changes in bone mineral density (BMD) in women due to estrogen decline during menopause and its relationship to the increased risk of bone fractures are well‐established.

• WHAT QUESTION DID THIS STUDY ADDRESS?

What is the magnitude of longitudinal natural change in BMD in untreated premenopausal women and its relationship to the 10‐year fracture risk?

• WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE?

This study quantified the magnitude of longitudinal natural decline in femoral neck BMD in premenopausal women across healthy and patient populations and its translation to long‐term postmenopausal fracture risk, using real‐world data (RWD) and clinical trials data coupled with modeling and simulation.

• HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE?

This study provides a model‐informed drug development (MIDD) approach that integrates RWD and clinical trials data to evaluate bone health quantitatively and longitudinally in premenopausal women. Our MIDD approach enables prediction of the magnitude of change in BMD and fracture risk due to medical treatments over time to inform the risk‐benefit evaluation of new therapies.     

Correlation of Tibial Low-Frequency Ultrasound Velocity with Femoral Radiographic Measurements and BMD in Elderly Women

The ultrasonic axial transmission technique has been proposed as a method for cortical bone characterization. Using a low enough center frequency, Lamb modes can be excited in long bones. Lamb waves propagate throughout the cortical bone layer, which makes them appealing for characterizing bone material and geometrical properties. In the present study, a prototype low-frequency quantitative ultrasonic axial transmission device was used on elderly women (n = 132) to investigate the relationships between upper femur geometry and bone mineral density (BMD) and tibial speed of sound. Ultrasonic velocities (V) were recorded using a two-directional measurement set-up on the midtibia and compared with dual-energy X-ray absorptiometry measurements and plain radiographs of the hip. Statistically significant, but weak, correlations were found between V and femoral shaft cortex thickness measured from radiographs (r = 0.20–0.26). V also correlated significantly with various BMD and bone mineral content parameters (r = 0.20–0.35). Femoral BMD and geometry were found to be significant independent predictors of V (R² = 0.07–0.16, p < 0.01). This study showed that femoral geometry and BMD affect significantly the axial ultrasound velocity measured at the tibia. In addition, the results confirmed, for the first time, a relationship between tibial ultrasound velocity and cortical bone thickness at the proximal femur. (E-mail: mikko.j.maatta@oulu.fi)     

Is obesity protective for osteoporosis? Evaluation of bone mineral density in individuals with high body mass index

Background: Obese individuals often present comorbidities while they appear protected against the development of osteoporosis. However, few and contradictory data are now available on skeletal modifications in obese patients. The aim of this study was to characterise bone mineral density (BMD) in overweight (BMI > 25 < 29.9) and obese (BMI > 30) patients. Methods: We selected 398 patients (291 women, 107 men, age 44.1 + 14.2 years, BMI 35.8 + 5.9 kg/m²) who underwent clinical examination, blood tests and examination of body composition. Subjects with chronic conditions or taking medications interfering with bone metabolism, hormonal and nutritional status and recent weight loss were excluded. Results: Interestingly, 37% (n = 146) of this population showed a significantly lower than expected lumbar BMD: 33% (n = 98) of women showed a T‐score ?1.84 ± 0.71, and 45% (n = 48) of men showed a T‐score ?1.88 ± 0.64. When the population was divided into subgroups based on different BMI, it was noted that overweight (BMI > 25 < 29.9) was neutral or protective for BMD, whereas obesity (BMI > 30) was associated with a low bone mass, compatible with a diagnosis of osteoporosis. No differences were observed in hormones and lipid profiles among subgroups. Conclusions: Our results indicate that a subpopulation of obese patients has a significant low lumbar BMD than expected for age. Thus, a careful characterisation of skeletal metabolism might be useful in all obese individuals to avoid fragility fractures later in life.     

定量CT测量女性颈椎与腰椎骨密度

目的 探讨女性颈椎骨密度与腰椎骨密度的差异及相关性。方法 对46名女性志愿者于同一天行颈椎及腰椎定量CT(QCT)扫描,记录各椎体骨密度数据。分别应用配对样本t检验及Pearson相关分析比较颈椎与腰椎平均骨密度的差异及相关性;采用方差分析比较各椎体骨密度均数,采用LSD法进行组间的两两比较。结果 颈椎平均骨密度为(281.81±76.13)mg/cm³,腰椎为(147.49±39.65)mg/cm³,二者差异有统计学意义(t=19.462,P<0.001)。颈椎与腰椎平均骨密度的相关性高(r=0.86,P<0.001)。结论 女性颈椎平均骨密度高于腰椎,并与腰椎平均骨密度相关性高。     

99Tcm-MDP骨显像腰椎标准摄取值与骨密度的相关性

目的 观察不同骨密度（BMD）患者⁹⁹Tc^m-亚甲基二磷酸盐（⁹⁹Tc^m-MDP）骨显像腰椎标准摄取值（SUV）的差异，并分析其与BMD的相关性。方法 回顾性分析62例接受⁹⁹Tc^m-MDP全身骨显像、腰椎SPECT/CT断层显像及双能X线腰椎BMD检测患者，根据BMD结果将其分为骨量正常组（n=18）、骨量减低组（n=24）和骨质疏松组（n=20），比较3组腰椎平均SUV（SUV_mean）、最大SUV（SUV_max）及BMD等的差异，分析其与腰椎平均CT值、患者年龄、体质量及身高的相关性。结果 腰椎SUV_max和SUV_mean分别为7.39±1.84和4.90±1.27，均与BMD呈正相关（r=0.64、0.63，P均<0.01）。腰椎SUV_max、SUV_mean和BMD均与年龄呈负相关（r=-0.33、-0.44、-0.43，P均<0.05），与体质量（r=0.42、0.30、0.35）及平均CT值（r=0.56、0.59、0.73）呈正相关（P均<0.05），与身高无明显相关（P均>0.05）。3组间腰椎SUV_max、SUV_mean、BMD和平均CT值差异均有统计学意义（F=24.09、30.50、94.85、30.24，P均<0.01）。骨量减低组腰椎SUV_max、SUV_mean、BMD和平均CT值明显低于正常组（P均<0.01）；骨质疏松组明显低于骨量正常组和骨量减低组（P均<0.01）。结论 ⁹⁹Tc^m-MDP骨显像腰椎SUV可用于评价骨质疏松及评估疗效。腰椎SUV_max及SUV_mean均与BMD呈正相关。骨质疏松患者腰椎SUV_max和SUV_mean明显降低。     

Relationship between bone mineral density and biochemical markers of bone turnover in hemodialysis patients

End-stage renal disease is closely associated with changes in bone and mineral metabolism. In recent times, osteoporosis has become important among hemodialysis (HD) patients. In this study, the investigators sought to evaluate the relationship between bone mineral density (BMD) and biochemical markers of bone turnover among HD patients. A total of 70 uremic patients on a maintenance HD program for at least 1 y were enrolled in the study. All patients were treated with conventional bicarbonated HD for 5 h through the use of low-flux hollow-fiber dialyzers. Bone densitometry was measured by dual energy x-ray absorptiometry in the lumbar spine (LS) and the femoral neck (FN). BMD was classified according to World Health Organization criteria on the basis of BMD T scores. Biochemical bone turnover markers such as calcium, phosphorus, ionized calcium, intact parathyroid hormone, alkaline phosphatase, plasma bicarbonate, blood pH, serum albumin, and hematocrit levels were measured before the HD session in the morning. Male patients (n=37; 52.9%; mean age, 46.2+/-17.0 y) were assigned to a single study group, and female patients (n=33; 47.1%; mean age, 44.0+/-13.1 y) to another. Mean duration of HD treatment was 33.7+/-28.5 mo in females and 33.0+/-26.0 mo in males. Among all patients, BMD T scores in the osteopenia/osteoporosis range were observed at the LS in 58 patients (82.8%) and at the FN in 45 patients (64.3%). According to BMD measurements in FN T score, 10% of patients (n=7) were osteoporotic, 54.3% (n=38), osteopenic, and 35.7% (n=25), normal. On the other hand, in LS T score, the results were 47.1% (n=33) osteoporotic, 35.7% (n=25), osteopenic, and 17.1% (n=12), normal. No statistically significant association was found in osteopenia/osteoporosis between sexes according to FN and LS T score (P=.542, P=.267, respectively). No significant relationship was noted between BMD and biochemical markers of bone turnover. A positive correlation was found between FN T scores of BMD and age (r=.413, P=.000). BMD T scores within the range of scores for osteopenia/osteoporosis were observed in 78.5% of patients at the LS and in 58.5% of patients at the FN. The investigators concluded that no correlation could be found between markers of bone turnover and bone mass measurements in both skeletal regions. LS T score results were worse than FN T score results. Elevated alkaline phosphastase levels combined with high intact parathyroid hormone levels are predictive of renal osteodystrophy but not of adynamic bone disease/osteoporosis.     

基于定量CT分析不同性别腰椎骨密度和血脂的相关性

目的 采用定量CT（QCT）测量腰椎骨密度（BMD）,探讨不同性别腰椎BMD与血脂的相关性。方法 选取670名接受体检的中老年人,男341名,女329名,计算体质量指数（BMI）;空腹采集静脉血检测总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）及低密度脂蛋白胆固醇（LDL-C）;使用QCT进行腰椎BMD测量,根据其结果分为骨量正常组、骨量减低组及骨质疏松组,分析3组不同性别腰椎BMD的差异及腰椎BMD与各血脂参数的相关性。以腰椎BMD为因变量,男性和女性差异有统计学意义的参数为自变量,进行多元线性回归分析。结果 男性骨量减低组TC和LDL-C均高于骨量正常组（P均<0.05）;女性骨质疏松组及骨量减低组TC高于骨量正常组,骨量减低组LDL-C高于骨量正常组（P均<0.05）。男性腰椎BMD与年龄、BMI及HDL-C均呈负相关（P均<0.05）,女性腰椎BMD与年龄、TC、TG及LDL-C均呈负相关（P均<0.05）。多元线性回归结果显示年龄是导致中老年人腰椎BMD下降的危险性因素。结论 血脂异常与中老年腰椎BMD下降存在相关性,年龄是导致中老年人腰椎BMD下降的危险性因素。