通过外周定量计算机断层扫描（pQCT）评估原发性甲状旁腺功能亢进症中的几何结构和骨量。

Geometry and bone mass in primary hyperparathyroidism assessed by peripheral Quantitative Computed Tomography (pQCT).

作者信息

Di Leo Claudio, Bestetti Alberto, Bastagli Amelia, De Pasquale Loredana, Tagliabue Luca, Bagni Bruno, Pepe Leonardo, Tarolo Gian Luigi

机构信息

Servizio di Medicina Nucleare, Cattedra e Scuola di Specializzazione in Medicina Nucleare, Ospedale S. Paolo, Università degli Studi di Milano, Milano, Italy.

出版信息

Radiol Med. 2003 Mar;105(3):171-9.

PMID:12835640

Abstract

PURPOSE

Non-invasive measurement by peripheral quantitative computed tomography (pQCT) of bone geometry, biomechanics, and mineral content in patients (pts) with primary hyperparathyroidism (PHPT).

MATERIALS AND METHODS

Total, trabecular and cortical mineral density (totBMD, cortBMD, trab BMD), bone geometrical properties (total area, trabecular area, cortical area, cortical/total area) and cortical thickness as biomechanical parameters, were assessed by pQCT at distal radius in 38 (32 F; 6 M) consecutive patients with PHPT (mean age: 62 yrs; range: 30-77). In a subgroup of 12 patients, bone mineral density (BMD) was also measured by means of dual X-ray absorptiometry (DXA) at the lumbar spine (L2-L4).

RESULTS

Serum biochemical characteristics were: iPTH (269+/-214 pg/ml; range: 107-1438, normal: 30-65), Calcium (11.4+/-1.1 mg/dl; range: 10.6-13.5, normal: 8.1-10.4) and Alkaline Phosphatase (398+/- 392 U/L; range:173-1174, normal: 98-279). Compa-red with 87 healthy age-matched subjects, total, trabecular and cortical bone densities were reduced in all patients (TotBMD: 216+/-92 mg/cm(3) vs ctr 342+/-94, -37%, p<0.05; TrabBMD: 93+/-51 mg/cm(3) vs ctr 140+/-54, -34%, p <0.01; CorBMD: 711+/-178 mg/cm(3) vs ctr 802+/-175, -11%, p<0.02), such as cortical thickness (0.143+/-0.02 cm vs ctr 0.157+/-0.03, -9%, p<0.02). Among geometrical parameters, only cortical/total area was significant different in the two groups (0,29 vs 0.31; p<0.04). A strong correlation was found between peripheral trabecular bone density assessed by pQCT and axial bone mineral density measured by DXA at L2-L4 (r=0.80; p<0.01).

CONCLUSIONS

pQCT measurements in PHPT showed: 1) osteopoenia in all bone compartments partly related to age and menopause; 2) reduced cortical density and cortical thickness consistent with "cancellization" of the inner cortex and lower ability of bone to absorb loading forces. DXA measurements showed osteopoenia also at the lumbar spine, a site rich in trabecular bone. PQCT allowing selective assessment of true volumetric cortical and trabecular bone density such as bone geometry, is proposable in clinical practice, in order to evaluate presurgical bone "status" and to monitor the response to parathyroidectomy.

摘要

目的

通过外周定量计算机断层扫描（pQCT）对原发性甲状旁腺功能亢进症（PHPT）患者的骨几何结构、生物力学和矿物质含量进行无创测量。

材料与方法

通过pQCT对38例（32例女性；6例男性）连续的PHPT患者（平均年龄：62岁；范围：30 - 77岁）的桡骨远端进行总骨、小梁骨和皮质骨矿物质密度（总骨密度、皮质骨密度、小梁骨密度）、骨几何特性（总面积、小梁面积、皮质面积、皮质/总面积）以及作为生物力学参数的皮质厚度进行评估。在12例患者的亚组中，还通过双能X线吸收法（DXA）测量腰椎（L2 - L4）的骨矿物质密度（BMD）。

结果

血清生化特征为：甲状旁腺激素（iPTH）（269±214 pg/ml；范围：107 - 1438，正常：30 - 65）、钙（11.4±1.1 mg/dl；范围：10.6 - 13.5，正常：8.1 - 10.4）和碱性磷酸酶（398±392 U/L；范围：173 - 1174，正常：98 - 279）。与87例年龄匹配的健康受试者相比，所有患者的总骨、小梁骨和皮质骨密度均降低（总骨密度：216±92 mg/cm³ 对比对照组342±94，-37%，p<0.05；小梁骨密度：93±51 mg/cm³ 对比对照组140±54，-34%，p <0.01；皮质骨密度：711±178 mg/cm³ 对比对照组802±175，-11%，p<0.02），皮质厚度也是如此（0.143±0.02 cm对比对照组0.157±0.03，-9%，p<0.02）。在几何参数中，两组之间只有皮质/总面积有显著差异（0.29对比0.31；p<0.04）。通过pQCT评估的外周小梁骨密度与通过DXA测量的L2 - L4轴向骨矿物质密度之间存在强相关性（r = 0.80；p<0.01）。

结论

PHPT患者的pQCT测量结果显示：1）所有骨腔室均存在骨质减少，部分与年龄和绝经有关；2）皮质密度和皮质厚度降低，与内皮质的“骨小梁化”以及骨吸收负荷力的能力降低一致。DXA测量显示富含小梁骨的腰椎部位也存在骨质减少。由于pQCT能够选择性地评估真正的体积性皮质骨和小梁骨密度以及骨几何结构，因此在临床实践中建议使用，以便评估手术前的骨“状态”并监测甲状旁腺切除术后的反应。