摘要目的 探讨能谱CT成像对Graves甲状腺功能亢进症(简称甲亢)患者骨量评估的价值,以及131I治疗对Graves甲亢患者骨量的影响.方法 收集2015年6月至10月期间在我科接受131I治疗的68例Graves甲亢患者[(男性13例、女性55例,年龄(40.6±10.7)岁],治疗前采用双能X线吸收法(DXA)测定腰椎骨密度(BMD),能谱CT测定第3腰椎钙(水)密度,采用Pearson相关分析及线性回归探讨二者的相关性.治疗后半年随访评价疗效,复查腰椎能谱CT,采用配对t检验比较131I治疗前后骨量变化.结果 DXA的测定结果显示,68例Graves甲亢患者中有21例伴有骨量减少(30.9％),7例伴有骨质疏松(10.3％).骨量正常组患者的第3腰椎钙(水)密度为(64-33±14.65) g/cm3,骨量减少组为(48.29±4.45) g/cm3,而骨质疏松组为(41.65±1.21)g/cm3,3组间差异有统计学意义(x2=35.811,P＜0.001).骨量正常组患者的第3腰椎BMD为(1.252±0.305) g/cm2,骨量减少组为(1.103±0.254)g/cm2,而骨质疏松组为(0.539±0.066) g/cm2,3组间差异有统计学意义(F=12.968,P＜0.001).Graves甲亢患者的第3腰椎钙(水)密度与DXA测定的腰椎BMD呈高度正相关(r=0.794,假设检验水准α=0.01,t=10.605,P＜0.001).由线性回归分析得到线性回归方程:第3腰椎钙(水)密度=24.485+34.529腰椎BMD.治疗后半年随访发现,甲亢治愈组患者131I治疗后腰椎钙(水)密度较治疗前增加,骨量改善,差异有统计学意义(t=7.86,P＜0.001);而甲亢未愈组患者较治疗前变化不显著,差异无统计学意义(t=2.29,P=0.062).结论 能谱CT测得的腰椎钙(水)密度可用于评估Graves甲亢患者的骨量.患者经131I治疗后,骨量可随着甲亢的有效缓解而显著改善.

abstractsObjective To investigate the value of CT spectral imaging to evaluate bone mass in patients with Graves' hyperthyroidism,and the changes of bone mass before and after 131I therapy.Methods Sixty-eight patients(13 males,55 females;age 40.6±10.7yr) with Graves' hyperthyroidism who received 131I therapy from June to October 2015 were involved in our study.The bone mineral density(BMD) of lumbar was obtained by dual energy X-ray absorptiometry(DXA),and the calcium-water concentration of L3 was measured by CT spectral imaging before 131I therapy.Pearson correlation analysis and linear regression were performed to explore the relationship between them.All clinical data were collected to assess the efficacy of 131I therapy after 6 months.CT spectral imaging was repeated,in order to compare the changes of bone mass using comparative t-test.Results Of these patients with Graves' hyperthyroidism,30.9％ (21/68) patients with osteopenia and 10.3％(7/68) patients with osteoporosis were diagnosed according to the results of BMD by DXA.The calcium (water) densities of L3 were (64.33±14.65),(48.29±4.45) and (41.65t1.21) g/cm3 in patients with normal bone mass,bone loss and osteoporosis,respectively.The differences between the three groups were statistically significant (,2=-35.811,P＜0.001).The bone mineral density of L3 were (1.252±0.305),(1.103±0.254) and (0.539±0.066) g/cm3 in patients with normal bone mass,bone loss and osteoporosis,respectively.The differences between the three groups were statistically significant (F=12.968,P＜0.001).The calcium-water concentrations of L3 (g/cm3) were highly correlated with BMD values (g/cm2) of lumbar determined by DXA(r=0.794,hypothesis testing standard α=0.01,t=10.605,P＜0.001).Equation of linear regression:the calcium-water concentration of L3=24.485+34.529 BMD value of lumbar.Furthermore,after 131I therapy,the calcium-water concentrations of L3 increased(t=7.86,P＜0.001) in the cured group of patients.But there weren't significant difference in the uncured group of patients(t=2.29,P=0.062).Conclusions CT spectral imaging can be used to evaluate bone mass in patients with Graves' hyperthyroidism.Bone mass can be improved with remission of hyperthyroidism after 131I therapy.