超声和x线检查类风湿关节炎患者骨病变的频率和性质Оsteodensitometry及其在评估骨密度中的诊断价值

V. Chemes, U. Abrahamovych, L. Tsyhanyk, S. Guta
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A randomized study with a preliminary stratification for RA diagnosed according to the criteria of the American College of Rheumatologists and the European League Against Rheumatism in 2010, premenopausal women and adult men, included 74 patients (62 women (84.93 %) and 12 men (15.07 %) aged 38 to 60 years (mean age at the time of the survey women - 48.67 ± 2.34 years, men - 45.42 ± 2.78) treated, receiving methylprednisolone at a dose of 4.0 to 24.0 mg/day and not receiving drugs for the treatment of OP) in the rheumatology department of the Municipal Non-Profit Enterprise of the Lviv Regional Council “Lviv Regional Clinical Hospital” from 2013 to 2019 (research group - DG). The control group (CG) was composed of 29 healthy individuals (22 women (75.86 %) and 7 men (24.14 %), the average age of women at the time of the survey was 44.95 ± 2.12 years, men - 40.71 ± 2.75 years) of the same sex and age. All patients underwent assessment of BMD with ultrasound densitometry, X-ray densitometry of the hand. Results. In most patients with rheumatoid arthritis ultrasound densitometry revealed violations of bone mineral density, of which osteopenia was in 34 (45.95 %) patients (of whom first degree in 3 (4.05 %), second degree in 18 (24, 32.00 %), III degree in 13 (17.57 %)), osteoporosis in 22 (29.73 %), and within the reference indicators - in 18 (24.32 %). X-ray densitometry in all patients with rheumatoid arthritis revealed a violation of bone mineral density, of which osteopenia was 46 (62.17 %), of which I degree in 19 (25.68 %), II degree in 14 (18.92 %), III degree in 13 (17.57 %)), osteoporosis - in 28 (37.83 %). Analysis of correlations between the results of BMD assessment by ultrasound of heel bone densitometry and X-ray densitometry of the hand in patients with RA revealed a direct strong correlation between the T-test, obtained by ultrasound of heel densitometry and X-ray densitometry of the hand in patients with RA (r = 0.44; p value less than 0.001); indicating that with a decrease in the T-test according to ultrasound densitometry will decrease the T-test according to X-ray densitometry, which allows to diagnose changes in BMD by both methods in patients with RA. It was found that in patients with RA reduction of BMD by ultrasound densitometry of the heel bone in 100.00 % of cases is confirmed by the results of X-ray densitometry of the hand (sensitivity 0.1). Conclusions. 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引用次数: 0

摘要

介绍。类风湿关节炎(RA)是一种病因不明的复杂自身免疫发病机制,是一种慢性全身性结缔组织疾病,常并发继发性骨质疏松症(OS),使基础疾病的病程和预后恶化。研究的目的。目的探讨超声和x线骨密度仪检测类风湿关节炎患者骨损伤的频率和性质,确定其在评估骨密度中的诊断价值。材料和方法。根据2010年美国风湿病学会和欧洲抗风湿病联盟的标准对RA进行初步分层的随机研究,绝经前女性和成年男性,包括74例患者,其中62例女性(84.93%)和12例男性(15.07%),年龄在38至60岁之间(调查时平均年龄女性为48.67±2.34岁,男性为45.42±2.78)。2013年至2019年,在利沃夫地区议会市政非营利企业“利沃夫地区临床医院”风湿病科接受甲基强的松龙剂量为4.0至24.0 mg/天,未接受治疗OP的药物)(研究小组- DG)。对照组(CG)由29名健康个体组成,其中女性22人(75.86%),男性7人(24.14%),调查时女性平均年龄为44.95±2.12岁,男性平均年龄为40.71±2.75岁。所有患者均通过超声密度测量和手部x线密度测量评估骨密度。结果。多数类风湿关节炎患者超声密度检查显示骨密度异常,其中骨质减少34例(45.95%),其中1级3例(4.05%),2级18例(24、32.00%),3级13例(17.57%),骨质疏松22例(29.73%),符合参考指标18例(24.32%)。所有类风湿关节炎患者x线密度检查均发现骨密度异常,其中骨质减少46例(62.17%),其中ⅰ级19例(25.68%),ⅱ级14例(18.92%),ⅲ级13例(17.57%),骨质疏松28例(37.83%)。对RA患者超声骨密度与手部x线骨密度评估结果的相关性分析显示,RA患者超声骨密度与手部x线骨密度的t检验结果具有直接的强相关性(r = 0.44;P值小于0.001);表明超声密度测定t检验值降低,x线密度测定t检验值也会降低,从而可以用两种方法诊断RA患者骨密度的变化。研究发现,在RA患者中,100.00%的病例通过超声测量脚跟骨骨密度来证实骨密度降低,其结果与手部x线骨密度测量结果一致(灵敏度0.1)。结论。研究表明,确定类风湿关节炎患者骨组织的矿物质密度,需要使用可用的,因此不昂贵,安全,无创,无或只有最小的辐射暴露,适合筛选的方法,建议满足这些要求的方法是超声密度测定法和x射线密度测定法,首选后者。
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Frequency and Nature of Bone Lesions in Patients with Rheumatoid Arthritis Detected by Ultrasound and X-ray Оsteodensitometry, their Diagnostic Value in Assessing Bone Mineral Density
Introduction. Rheumatoid arthritis (RA) is an unknown etiology of complex autoimmune pathogenesis, a chronic systemic connective disease that is often complicated by secondary osteoporosis (OS), which worsens the course and prognosis of the underlying disease. The aim of the study. To establish the frequency and nature of bone damage in patients with rheumatoid arthritis detected by ultrasound and X-ray densitometry, to determine their diagnostic value in assessing bone mineral density. Materials and methods. A randomized study with a preliminary stratification for RA diagnosed according to the criteria of the American College of Rheumatologists and the European League Against Rheumatism in 2010, premenopausal women and adult men, included 74 patients (62 women (84.93 %) and 12 men (15.07 %) aged 38 to 60 years (mean age at the time of the survey women - 48.67 ± 2.34 years, men - 45.42 ± 2.78) treated, receiving methylprednisolone at a dose of 4.0 to 24.0 mg/day and not receiving drugs for the treatment of OP) in the rheumatology department of the Municipal Non-Profit Enterprise of the Lviv Regional Council “Lviv Regional Clinical Hospital” from 2013 to 2019 (research group - DG). The control group (CG) was composed of 29 healthy individuals (22 women (75.86 %) and 7 men (24.14 %), the average age of women at the time of the survey was 44.95 ± 2.12 years, men - 40.71 ± 2.75 years) of the same sex and age. All patients underwent assessment of BMD with ultrasound densitometry, X-ray densitometry of the hand. Results. In most patients with rheumatoid arthritis ultrasound densitometry revealed violations of bone mineral density, of which osteopenia was in 34 (45.95 %) patients (of whom first degree in 3 (4.05 %), second degree in 18 (24, 32.00 %), III degree in 13 (17.57 %)), osteoporosis in 22 (29.73 %), and within the reference indicators - in 18 (24.32 %). X-ray densitometry in all patients with rheumatoid arthritis revealed a violation of bone mineral density, of which osteopenia was 46 (62.17 %), of which I degree in 19 (25.68 %), II degree in 14 (18.92 %), III degree in 13 (17.57 %)), osteoporosis - in 28 (37.83 %). Analysis of correlations between the results of BMD assessment by ultrasound of heel bone densitometry and X-ray densitometry of the hand in patients with RA revealed a direct strong correlation between the T-test, obtained by ultrasound of heel densitometry and X-ray densitometry of the hand in patients with RA (r = 0.44; p value less than 0.001); indicating that with a decrease in the T-test according to ultrasound densitometry will decrease the T-test according to X-ray densitometry, which allows to diagnose changes in BMD by both methods in patients with RA. It was found that in patients with RA reduction of BMD by ultrasound densitometry of the heel bone in 100.00 % of cases is confirmed by the results of X-ray densitometry of the hand (sensitivity 0.1). Conclusions. The study demonstrated that determining the mineral density of bone tissue in patients with rheumatoid arthritis, which requires the use of available, and therefore not expensive, safe, non-invasive, without or with minimal radiation exposure, suitable for screening methods, suggests that these requirements are met methods of ultrasonic densitometry and X-ray densitometry, preferring the latter.
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