切换至 "中华医学电子期刊资源库"
高级检索
中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2022, Vol. 08 ›› Issue (05) : 285 -289. doi: 10.3877/cma.j.issn.2096-0263.2022.05.006

骨质疏松

椎体CT值对原发性骨质疏松症唑来膦酸钠疗效的评价价值
雷礼辉1, 李峰2,†(), 罗光平1, 刘洪1, 杨骐彰3, 吴涛1, 翁睿1   
  1. 1. 418000　怀化市第一人民医院　脊柱外科
    2. 418000　怀化，湖南医药学院第一附属医院骨科
    3. 418000　怀化，湖南医药学院影像科
  • 收稿日期:2022-03-15 出版日期:2022-10-05
  • 通信作者: 李峰
  • 基金资助:
    湖南省自然科学基金项目(2015JJ4037)

Predictive value of changes in CT value of vertebral body for the efficacy of zoledronate sodium in primary osteoporosis

Lihui Lei1, Feng Li2,†(), Guangping Luo1, Hong Liu1, Qizhang Yang3, Tao Wu1, Rui Weng1   

  1. 1. Department of Spine Surgery, Huaihua First People's Hospital, Huaihua 418000, China
    2. Department of Orthopedics, the First Affiliated Hospital of Hunan Medical College, Huaihua 418000, China
    3. Department of Imaging, Hunan Medical College, Huaihua 418000, China
  • Received:2022-03-15 Published:2022-10-05
  • Corresponding author: Feng Li
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

雷礼辉, 李峰, 罗光平, 刘洪, 杨骐彰, 吴涛, 翁睿. 椎体CT值对原发性骨质疏松症唑来膦酸钠疗效的评价价值[J/OL]. 中华老年骨科与康复电子杂志, 2022, 08(05): 285-289.

Lihui Lei, Feng Li, Guangping Luo, Hong Liu, Qizhang Yang, Tao Wu, Rui Weng. Predictive value of changes in CT value of vertebral body for the efficacy of zoledronate sodium in primary osteoporosis[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2022, 08(05): 285-289.

目的

探讨椎体CT值变化对原发性骨质疏松症（OP）唑来膦酸钠疗效的评价价值。

方法

选取2018年5月至2021年4月医院收治的152例原发性OP患者为研究对象，所有患者均采用唑来膦酸钠治疗，统计治疗后12个月疗效。收集患者临床资料，采用Logistic回归分析影响原发性OP患者唑来膦酸钠治疗疗效的因素，用受试者工作特征（ROC）曲线分析影响因素对原发性OP唑来膦酸钠疗效的评价价值。

结果

152例原发性OP患者脱落2例，剩余150例患者中59例患者疗效满意，91例患者疗效不佳。将单因素分析有统计学意义的LDLC水平、25-羟维生素D、腰椎体骨松质L1 △CT值为自变量进行Logistic回归分析，结果显示腰椎体骨松质L1 △CT值（OR=4.084，95% CI：1.680，9.925）、25-羟维生素D（OR=3.640，95% CI：1.498，8.847）是影响原发性OP唑来膦酸钠疗效的独立因素（P<0.05）。ROC曲线显示腰椎体骨松质L1 △CT值评价原发性OP唑来膦酸钠疗效的AUC高于25-羟维生素D（P<0.05）。

结论

原发性OP患者存在唑来膦酸钠治疗疗效不佳风险，椎体CT值变化、25-羟维生素D水平与原发性OP唑来膦酸钠疗效有关，且二者评价原发性OP唑来膦酸钠疗效效能良好。

关键词: 原发性骨质疏松症, 椎体CT值, 唑来膦酸钠疗效, 评价价值
Objective

To explore the predictive value of CT value changes of vertebral body for the efficacy of zoledronate sodium in primary osteoporosis (OP).

Methods

152 patients with primary OP who were admitted to the hospital from May 2018 to April 2021 were selected as the research objects. All patients were treated with zoledronic sodium, and the curative effect was calculated 12 months after treatment. Patient clinical data were collected. Logistic regression was used to analyze the factors that affect the efficacy of zoledronate in patients with primary OP. Receiver operating characteristic (ROC) curve was used to analyze the evaluation value of influencing factors on the efficacy of zoledronate in primary OP.

Results

2 patients dropped out. Among the remaining 150 patients, 59 patients had satisfactory curative effects, and 91 patients had poor curative effects of the 152 patients with primary OP. Logistic multivariate regression analysis showed that lumbar vertebral body cancellous bone L1 △CT value (OR=4.084, 95% CI: 1.680, 9.925), 25-hydroxyvitamin D (OR=3.640, 95% CI: 1.498, 8.847) were the influencing factors Independent factors for the efficacy of zoledronate sodium in patients with OP. The ROC curve showed that the AUC of lumbar vertebral cancellous bone L1 △CT value in evaluating the efficacy of primary OP zoledronate was higher than that of 25-hydroxyvitamin D.

Conclusions

Patients with primary OP are at risk of poor efficacy of zoledronate treatment. The changes of vertebral CT value and 25-hydroxyvitamin D level are related to the efficacy of zoledronate in primary OP. OP zoledronate has good efficacy.

Key words: Primary osteoporosis, CT value of vertebral body, Efficacy of zoledronate sodium, Predictive value
图2 椎体CT值测量
表1 疗效不佳者及疗效满意者临床资料比较[例（%）]
  因素 疗效不佳者（n=91） 疗效满意者（n=59） t/χ2值 P值
性别     1.059 0.304
  男性 40（43.96） 31（52.54）    
  女性 51（56.04） 28（47.46）    
年龄（岁）     0.186 0.666
  ≥60 34（37.36） 20（33.90）    
  <60 57（62.64） 39（66.10）    
体质量指数（kg/m2）     0.040 0.841
  <25 76（83.52） 50（84.75）    
  ≥25 15（16.48） 9（15.25）    
吸烟史 30（32.97） 18（30.51） 0.099 0.753
饮酒史 20（21.98） 11（18.64） 0.243 0.622
TC（mmol/L） 4.70±0.81 4.51±0.62 1.533 0.127
TG（mmol/L） 2.26±0.37 2.31±0.33 0.843 0.401
HDLC（mmol/L） 1.43±0.22 1.46±0.21 0.830 0.408
LDLC（mmol/L） 2.35±0.39 1.99±0.35 5.746 <0.001
骨碱性磷酸酶（U/L） 82.35±12.30 81.21±11.65 0.566 0.572
血钙（mmol/L） 2.19±0.28 2.21±0.32 0.404 0.687
血磷（mmol/L） 1.27±0.21 1.29±0.23 0.549 0.584
25-羟维生素D（ug/l） 19.32±3.24 21.97±3.56 4.706 <0.001
腰椎体L1△CT值（HU）        
骨皮质 1.06±0.17 1.11±0.19 1.680 0.095
骨松质 3.04±0.42 5.09±0.71 22.214 <0.001
表2 影响原发性OP唑来膦酸钠疗效的Logistic多因素分析
因素 β SE Wald χ2 P OR 95% CI
腰椎体骨松质L1 △CT值 1.407 0.235 35.847 <0.05 4.084 1.680，9.925
25-羟维生素D 1.292 0.304 18.063 <0.05 3.640 1.498，8.847
图3 腰椎体骨松质L1 △CT值和25-羟维生素D评价原发性OP唑来膦酸钠疗效的ROC曲线
表3 腰椎体骨松质L1 △CT值和25-羟维生素D评价疗效的效能分析
指标 截断值 AUC 95% CI 灵敏度 特异度
腰椎体骨松质L1 △CT值 4.08 HU 0.754 0.656，0.852 74.19% 70.00%
25-羟维生素D 20.86 ug/l 0.703 0.565，0.813 78.90% 62.19%
1
Bouvard B, Annweiler C, Legrand E. Osteoporosis in older adults [J]. Joint Bone Spine, 2021, 88(3): 105135.
2
Sleeman A, Clements JN. Abaloparatide: a new pharmacological option for osteoporosis [J]. Am J Health Syst Pharm, 2019, 76(3): 130-135.
3
Reid IR. A broader strategy for osteoporosis interventions [J]. Nat Rev Endocrinol, 2020, 16(6): 333-339.
4
Kanis JA, Burlet N, Cooper C, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women [J]. Osteoporos Int, 2008, 19(4): 399-428.
5
Da Z, Li WS, Chao D, et al. The use of CT Hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases [J]. European Spine Journal, 2019, 28(8): 1758-1766.
6
Wang P, She W, Mao Z, et al. Use of routine computed tomography scans for detecting osteoporosis in thoracolumbar vertebral bodies [J]. Skeletal Radiol, 2021, 50(2): 371-379.
7
Mochizuki T, Yano K, Ikari K, et al. Safety and efficacy of zoledronic acid treatment with and without acetaminophen and eldecalcitol for osteoporosis [J]. Intern Med, 2021, 60(16): 2585-2591.
8
中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊疗指南(2017) [J].中华骨质疏松和骨矿盐疾病杂志, 2017, 10(5): 1674-2591.
9
Graffy PM, Lee SJ, Ziemlewicz TJ, et al. Prevalence of vertebral compression fractures on routine CT scans according to L1 trabecular attenuation: determining relevant thresholds for opportunistic osteoporosis screening [J]. AJR Am J Roentgenol, 2017, 209(3): 491-496.
10
Anthamatten A, Parish A. Clinical update on osteoporosis [J]. J Midwifery Womens Health, 2019, 64(3): 265-275.
11
Anam AK, Insogna K. Update on Osteoporosis Screening and Management [J]. Med Clin North Am, 2021, 105(6): 1117-1134.
12
Arceo-Mendoza RM, Camacho PM. Postmenopausal Osteoporosis: Latest Guidelines [J]. Endocrinol Metab Clin North Am, 2021, 50(2):167-178.
13
Slaton RM, Boyd K, Iranikhah M. Romosozumab and sequential therapy in postmenopausal osteoporosis [J]. Sr Care Pharm, 2020, 35(7): 297-308.
14
Fink HA, Macdonald R, Forte ML, et al. Long-term drug therapy and drug discontinuations and holidays for osteoporosis fracture prevention:a systematic review [J]. Ann Intern Med, 2019, 171(1): 37-50.
15
Irie TY, Irie T, Espinoza OA, et al. Three-dimensional distribution of CT attenuation in the lumbar spine pedicle wall [J]. Sci Rep, 2021, 11(1): 1709.
16
Trémollieres F. Assessment and hormonal management of osteoporosis [J]. Climacteric, 2019, 22(2): 122-126.
17
He J, Xu S, Zhang B, et al. Gut microbiota and metabolite alterations associated with reduced bone mineral density or bone metabolic indexes in postmenopausal osteoporosis [J]. Aging (Albany NY), 2020, 12(9): 8583-8604.
18
Xue F, Zhao Z, Gu Y, et al. 7,8-Dihydroxyflavone modulates bone formation and resorption and ameliorates ovariectomy-induced osteoporosis [J]. Elife, 2021, 10: e64872.
19
Al-Daghri NM, Yakout S, Ghaleb A, et al. Iron and 25-hydroxyvitamin D in postmenopausal women with osteoporosis [J]. Am J Transl Res, 2022, 14(3): 1387-1405.
[1] 张茜, 刘叶青, 康雪莹, 孙兵兵, 刘岩, 胡丽叶, 周亚茹. 血清铁蛋白与绝经后骨质疏松症的相关性分析[J/OL]. 中华老年骨科与康复电子杂志, 2023, 09(03): 166-171.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号