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脊柱结核骨代谢相 关指标水平变化及 影像学诊断分析

作者:韩宏生 杨文峰 薛成伟 赵万寅 崔海雄 郭 浩 高云展 陈 真 范 正

所属单位:陕西省延安市人民医院放射科 (陕西 延安 716000)

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摘要

目的 分析脊柱结核骨代谢指标 情况,并比较CT、MRI对脊柱结核的诊断 价值。方法 选取本院2014年1月-2016年1 月就诊的47例脊柱结核患者为观察组研究 对象,均行CT、MRI检查,观察比较CT、 MRI对脊柱结核椎体破坏、椎间盘受累、 椎管狭窄等征象的显示率。另外选择同期 健康体检50例正常人群为对照组,测定两 组骨钙素(BGP)等骨代谢指标。结果 CT对 脊髓受压显示率12.77%,MRI对脊髓受压 显示率40.43%,两者比较差异有统计学意 义(P<0.05),而两者在椎管狭窄、椎旁 软组织脓肿等征象显示上无显著差异(P> 0.05)。观察组与对照组血清碱性磷酸酶 (ALP)、I型胶原C端肽(CTX-I)水平比较差 异有统计学意义(P<0.05)。结论 CT、 MRI对脊柱结核椎间盘受累、椎管狭窄等 病变征象均能良好显示,但MRI在脊髓受 压显示上比CT显著高。血清ALP、CTX-I对 脊柱结核判断有一定的辅助作用。

Objective To analyze the bone metabolism related indexes of spinal tuberculosis, and to compare the value of CT and MRI in the diagnosis of spinal tuberculosis. Methods Forty-seven cases of patients with spinal tuberculosis who were treated in our hospital between January 2014 and January 2016 were enrolled in the observation group. All patients underwent CT and MRI examination. The display rates of CT and MRI in spinal tuberculosis with destroyed vertebral body, disc involvement and spinal canal stenosis were observed and compared. Another 50 cases of normal people who underwent health examination in the same period were selected as control group. Bone gla protein (BGP) and other bone metabolism indexes in the two groups were determined. Results The display rate of CT for spinal cord compression was 12.77% while MRI was 40.43% (P< 0.05). There was no significant difference in displaying spinal stenosis and paravertebral soft tissue abscess between the two methods (P>0.05). The differences in levels of serum alkaline phosphatase (ALP), type I collagen C terminal peptide (CTX-I) levels between the two groups were significant(P<0.05). Conclusion Both of CT and MRI can well display intervertebral disc involvement of spinal tuberculosis, spinal stenosis and other signs. However, the display rate of MRI in spinal cord compression is significantly higher than that of CT. The levels of serum ALP and CTX-I have an auxiliary effect on the diagnosis of spinal tuberculosis.

【关键词】脊柱结核;骨代谢指标;CT; MRI;影像学征象

【中图分类号】R445.2;R445.3; R529.2

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.08.041

前言

脊柱结核在全身骨结核中比较常见,其典型病理学特征为骨破坏 及吸收。脊柱结核早期症状复杂且不典型[1],仅通过观察临床症状易 漏诊或误诊,耽误病情,易发展成椎管狭窄等严重病症。为此临床常 结合影像学检查判断,如X线、CT或MRI,其中X线片诊断敏感度低, CT、MRI诊断敏感度、特异度均较高,但临床关于两者对脊柱结核影像 学特征显示仍存在一定的争议[2-3]。为此笔者对经病理证实的脊柱结核 患者CT、MRI影像学资料进行比较分析,以为脊柱结核临床诊断提供 依据。此外,近年来老年脊柱结核发病率逐年上升,多伴有骨质疏松 症,而关于结核病对骨代谢指标影响研究相对少。同时临床多数骨结 核由肺结核过继而成,为此选择一种标志物准确判断感染转移至骨是 否可行值得思考,这是笔者研究的另一重点。