定量CT在类风湿关节炎合并骨质疏松诊断中的应用价值

目的 分析定量CT（QCT）在类风湿关节炎（RA）合并骨质疏松（OP）诊断中的特异性和灵敏度,以及QCT评定RA患者骨量流失的影响因素,探讨QCT在RA患者合并OP诊断和病情评估中的价值。方法 选取112例确诊的类风湿关节炎患者为研究对象,QCT组（56例）,双能X线组（56例）,两组患者分别采用QCT及DXA检测骨密度。收集患者的一般资料,包括年龄、性别、体质指数、病程（月）、既往疾病和用药情况。同时收集患者的RA相关临床表现、辅助检查及骨密度检查结果。采用受试者工作特征曲线（ROC曲线）分析QCT诊断OP的特异性和灵敏度,多重线性回归分析QCT组患者骨量流失与RA临床表现、辅助检查的相关性。结果 ①经过对比,两组的一般资料差异无统计学意义（P>0.05);②DXA诊断类风湿关节炎患者合并骨质疏松的检出率为44.6 %,QCT测定类风湿关节炎患者合并骨质疏松的检出率为51.9 %。ROC曲线分析显示QCT对RA合并OP诊断的灵敏度为0.739,特异度为0.618;③QCT组研究对象的骨量流失与RA患者的临床表现、疾病活动指标无明显相关性（P>0.05）,但与RA特异性抗体抗核周因子抗体（APF）相关。结论 QCT对RA合并OP的检出率高于DXA,有着较好的灵敏度和特异性,可作为RA合并OP诊断的重要手段。

Application value of quantitative CT in the diagnosis of rheumatoid arthritis combined with osteoporosis

Objective To analyze the specificity and sensitivity of quantitative CT (QCT) in the diagnosis of rheumatoid arthritis (RA) complicated with osteoporosis (OP), as well as the influencing factors of bone loss in RA patients assessed by QCT, and to explore the value of QCT in the diagnosis and disease assessment of RA patients complicated with OP. Methods A total of 112 patients with confirmed rheumatoid arthritis were selected as research objects, including QCT group (56 cases) and dual-energy X-ray group (56 cases). Bone mineral density was measured by QCT and DXA respectively in the two groups. General information was collected, including age, sex, body mass index, disease duration (month), previous illness, and medication. Meanwhile, RA-related clinical manifestations, auxiliary examination and bone density examination results were collected. The receiver operating characteristic curve (ROC curve) was used to analyze the specificity and sensitivity of QCT for the diagnosis of OP, and multiple linear regression was used to analyze the correlation between bone loss in QCT group and the clinical manifestations and auxiliary examination of RA.Results 1. After comparison, there was no significant difference in general data between the two groups (P>0.05); The detection rate of osteoporosis in patients with rheumatoid arthritis was 44.6% by DXA and 51.9% by QCT. ROC curve analysis showed that the sensitivity and specificity of QCT for the diagnosis of RA combined with OP were 0.739 and 0.618.3. Bone loss in QCT group was not significantly correlated with clinical manifestations and disease activity indexes in RA patients (P>0.05), but was correlated with RA specific antibody anti-perinuclear factor antibody (APF). Conclusion The detection rate of RA combined OP by QCT is higher than that of DXA, and it has good sensitivity and specificity, which may be used as an important means for the diagnosis of RA combined with OP.