Chen Liuping, Pan Yaling, Zhong Fangyuan, Yuan Tian-Jiao, Wang Hanqi, Chen Tongtong, Lv Haiying, Cheng Xiaoguang, Liu Jian-Min, Lu Yong
Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Rehabilitation Medicine Center, Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
Ann Transl Med. 2022 May;10(10):606. doi: 10.21037/atm-22-1827.
Patients with primary hyperparathyroidism (PHPT) show changes in bone metabolism and adipose tissue, but the results are inconsistent. Quantitative computed tomography (QCT) was reported useful for detecting bone mineral and adipose tissue change, but information on the role of QCT in PHPT is limited. We aimed to explore the changes of lumbar bone mineral density (BMD) and abdominal adipose tissue in patients with PHPT using QCT based on existed CT images, and to assess the consistency between QCT and dual-energy X-ray absorptiometry (DXA) in assessing bone status.
This retrospective case-control study was conducted on 48 PHPT patients, with healthy controls (HCs) matched by their age (±3 years) and gender, and the case-to-control ratio was approximately 1:3. Volumetric bone mineral density (vBMD), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and total adipose tissue (TAT) were measured by QCT in both PHPT and control groups and compared with the independent samples T-test. In the PHPT group, areal bone mineral density (aBMD) was measured by DXA. Pearson correlation analysis was used to investigate the association between QCT-derived vBMD and DXA-derived aBMD. Weighted kappa consistency analysis was used to clarify the agreement between QCT and DXA.
Compared with HCs, the PHPT group had significantly lower vBMD (114.30±41.71 136.92±42.23 mg/cm; P=0.002) and higher TAT (261.98±74.65 236.69±69.00 cm; P=0.033); however, differences in SAT (120.81±40.19 109.94±36.83 cm; P=0.085) and VAT (141.17±48.11 126.75±50.50 cm; P=0.085) were not statistically significant. There was a strong correlation between QCT-derived vBMD and DXA-derived aBMD (all r>0.68; P<0.001), and a moderate consistency [kappa(w) =0.48; 95% CI: 0.29 to 0.68; P<0.001] was presented when defining bone status according to the respective diagnostic criteria.
Our study may provide useful information regarding bone status and abdominal adipose tissue change in patients with PHPT without requiring additional scan and may further extend the clinical application value of QCT.
原发性甲状旁腺功能亢进症（PHPT）患者存在骨代谢和脂肪组织的变化，但结果并不一致。有报道称定量计算机断层扫描（QCT）有助于检测骨矿物质和脂肪组织的变化，但关于QCT在PHPT中的作用的信息有限。我们旨在基于现有的CT图像，使用QCT探索PHPT患者腰椎骨密度（BMD）和腹部脂肪组织的变化，并评估QCT与双能X线吸收法（DXA）在评估骨状态方面的一致性。
本回顾性病例对照研究纳入了48例PHPT患者，并选取年龄（±3岁）和性别相匹配的健康对照（HCs），病例与对照的比例约为1:3。通过QCT测量PHPT组和对照组的体积骨密度（vBMD）、内脏脂肪组织（VAT）、皮下脂肪组织（SAT）和总脂肪组织（TAT），并采用独立样本t检验进行比较。在PHPT组中，通过DXA测量面积骨密度（aBMD）。采用Pearson相关分析研究QCT-derived vBMD与DXA-derived aBMD之间的关联。采用加权kappa一致性分析来阐明QCT与DXA之间的一致性。
与HCs相比，PHPT组的vBMD显著降低（114.30±41.71对136.92±42.23mg/cm；P=0.002），TAT更高（261.98±74.65对236.69±69.00cm；P=0.033）；然而，SAT（120.81±40.19对109.94±36.83cm；P=0.085）和VAT（141.17±48.11对126.75±50.50cm；P=0.085）的差异无统计学意义。QCT-derived vBMD与DXA-derived aBMD之间存在强相关性（所有r>0.68；P<0.001），并且在根据各自的诊断标准定义骨状态时呈现出中度一致性[kappa(w)=0.48；95%CI：0.29至0.68；P<0.001]。
我们的研究可能为PHPT患者的骨状态和腹部脂肪组织变化提供有用信息，而无需额外扫描，并可能进一步扩展QCT的临床应用价值。
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