原发性骨质疏松与多发性骨髓瘤致椎体压缩骨折的临床对比

Clinical study of vertebral compression fracture caused by primary osteoporosis and multiple myeloma

中文关键词:  原发性骨质疏松  多发性骨髓瘤  椎体压缩骨折  鉴别诊断

英文关键词:Primary osteoporosis  Multiple myeloma  Vertebral compression fracture  Differential diagnosis

中文摘要:

  【摘要】 目的：探究原发性骨质疏松与多发性骨髓瘤继发骨质疏松致椎体压缩骨折的临床特点、实验室检查和影像学表现，分析总结其差异。方法：回顾性分析2013年1月~2021年1月来我院脊柱脊髓外科就诊的132例椎体压缩骨折患者资料，其中经骨髓穿刺病理学检查诊断为多发性骨髓瘤38例（骨髓瘤组），原发性骨质疏松94例（骨质疏松组），均经双能X线骨密度测量仪诊断为“骨质疏松症”。比较两组患者性别、年龄、体重指数（body mass index，BMI）、疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）、是否贫血（血红蛋白是否＜100g/L）、白球比是否倒置、β2-微球蛋白（β2-MG）含量，病变椎体的数目、分布节段（颈椎、胸椎、腰椎）、形态（楔形、双凹形、扁平形）、CT密度变化、MRI信号（高信号、等信号、低信号）以及病变椎体椎弓根与附件是否受累等情况。将实验室检查有统计学差异者纳入二元Logistic回归分析，研究其与多发性骨髓瘤发生的相互关系，通过受试者工作特征（receiver operating characteristic，ROC）曲线验证各实验室检查与多发性骨髓瘤相关性的关系。结果：骨质疏松组男性22例，女性72例，年龄73.35±10.14岁，体重指数24.20±2.72kg/m2，骨髓瘤组男性21例，女性17例，年龄59.24±10.87岁，体重指数20.30±2.81kg/m2，两组性别、年龄、体重指数差异有统计学意义（P＜0.05）。骨质疏松组VAS评分为8.05±0.93分，ODI为（79.53±6.71）%，骨密度均值（T值）为-3.4±0.29SD；骨髓瘤组VAS评分为7.07±0.99分，ODI为（72.79±7.17）%，骨密度均值（T值）为-3.0±0.27SD，两组VAS评分、ODI、T值差异有统计学意义（P＜0.05）。骨质疏松组血红蛋白含量为122.48±1.17g/L，白球比为1.56±0.03，β2-MG含量为1.73±0.60mg/L，骨髓瘤组血红蛋白含量为79.24±3.81g/L，白球比为0.65±0.09，β2-MG为3.98±1.48mg/L，两组血红蛋白含量、白蛋白球蛋白比值、β2-MG含量差异有统计学意义（P＜0.05）。骨质疏松组白球比倒置10例，贫血2例，骨髓瘤组白球比倒置30例，贫血33例，两组白球比倒置、贫血比例差异有统计学意义（P＜0.05）；两组病变椎体分布差异无统计学意义（P＞0.05）；两组病变椎体楔形和扁平形改变差异有统计学意义（P＜0.05），双凹形改变差异无统计学意义（P＞0.05）；两组病变椎体CT横断面“虫蚀样”改变、病变椎体后缘成角、病变椎体内T1W1线性低信号影差异有统计学意义（P＜0.05）；两组病变椎体MRI信号、椎弓根受累差异无统计学意义（P＞0.05）。Logistic回归分析结果显示血红蛋白含量、白蛋白球蛋白比值、β2-MG含量是多发性骨髓瘤预测的独立因素（P＜0.05）。患者血红蛋白含量AUC为0.065，诊断敏感性为3%，特异性为100%，白蛋白球蛋白比值曲线下面积（aera under curve，AUC）为0.087，诊断敏感性为5%，特异性为98%，β2-MG含量AUC分为0.917，诊断敏感性为90%，特异性为97%。结论：原发性骨质疏松椎体压缩骨折老年女性多见，病变椎体T1W1可见线性低信号影；多发性骨髓瘤致椎体压缩骨折多发于中老年男性，病变椎体CT横断面可见“虫蚀样”溶骨性破坏，实验室检查常提示贫血、白球比倒置及β2-MG异常升高，血清β2-MG可作为诊断多发性骨髓瘤的一个敏感性指标。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical characteristics, laboratory results, imaging findings of vertebral compression fractures caused by osteoporosis secondary to primary osteoporosis and multiple myeloma, and to analyze and summarize the differences. Methods: A total of 132 patients with vertebral compression fractures who visited the Department of Spinal and Spinal Cord Surgery of our hospital from January 2013 to January 2021 were retrospectively analyzed, including 38 patients with multiple myeloma(myeloma group) and 94 patients with primary osteoporosis(osteoporosis group) diagnosed by bone marrow aspiration pathological examination. The gender, age, body mass index(BMI), visual analogue scale(VAS) for pain, Oswestry disability index(ODI), hemoglobin content and whether anemia(hemoglobin<100g/L), albumin-globulin ratio(A/G ratio) and whether inverted, β2-microglobulin(β2-MG) content, the number and distribution of diseased vertebral bodies(cervical vertebra, thoracic vertebra, lumbar vertebra), shape(wedge, double concave, flat shape), CT density change, MRI signal(high signal intensity, isointensity, low signal intensity) and whether the pedicle and accessories of diseased vertebral bodies are involved were compared between the two groups. Laboratory tests with P<0.05 were screened and included in binary logistic regression analysis to study their relationship with the occurrence of multiple myeloma, and finally the predictive relationship between each laboratory test and the correlation of multiple myeloma was verified by receiver operating characteristic(ROC) curves. Results: There were 22 males and 72 females in the osteoporosis group, aged 73.35±10.14 years, with a body mass index of 24.20±2.72kg/m2, and 21 males and 17 females in the myeloma group, aged 59.24±10.87 years, with a body mass index of 20.30±2.81kg/m2. There were significant differences in gender, age, and body mass index between the two groups(P<0.05). In osteoporosis group, VAS score was 8.05±0.93 points, ODI score was (72.79±7.17)%, bone mineral density T-score was -3.4±0.29SD; in myeloma group, VAS score was 7.07±0.99 points, ODI was (72.79±7.17)%, bone mineral density T-score was -3.0±0.27SD. There were significant differences in VAS score, ODI and bone mineral density T-value between the two groups(P<0.05). There were 10 cases of inverted ball ratio, 2 cases of anemia, 30 cases of inverted ball ratio in myeloma group, and 33 cases of anemia in osteoporosis group. There were significant differences in inverted ball ratio and anemia between the two groups(P<0.05). β2-MG was 1.73±0.60mg/L in the osteoporosis group and 3.98±1.48mg/L in the myeloma group, and there was a significant difference in β2-MG content between the two groups(P<0.05). There was no significant difference in the distribution of diseased vertebral bodies between the two groups(P>0.05). There was significant difference in wedge and flat change of diseased vertebral body between the two groups(P<0.05), but there was no significant difference in double concave change(P>0.05). There were significant differences in the "worm-like" changes in the CT cross-section of the diseased vertebral body, angulation of the posterior edge of the diseased vertebral body, and There was no significant difference in MRI signal and pedicle involvement of the diseased vertebral body between the two groups(P>0.05). The results of logistic regression analysis showed that hemoglobin content, albumin-to-globulin ratio, and β2-MG content were independent factors for multiple myeloma prediction(P<0.05). The AUC of hemoglobin content was 0.065, the diagnostic sensitivity was 3%, the specificity was 100%, the AUC of albumin-to-globulin ratio was 0.087, the diagnostic sensitivity was 5%, the specificity was 98%, the aera under curve(AUC) of β2-MG content was 0.917, the diagnostic sensitivity was 90%, and the specificity was 97%. Conclusions: Primary osteoporotic vertebral compression fractures are rare in elderly women, and linear hypointense shadows are observed in T1WI of the diseased vertebral body; vertebral compression fractures caused by multiple myeloma occur frequently in middle-aged and elderly men, and "worm-like" dissolution destruction is observed in the CT cross-section of the diseased vertebral body. Laboratory tests often suggest anemia, inverted white/ball ratio and abnormally elevated β2-MG. Serum β2-MG can be used as a sensitive indicator for the diagnosis of multiple myeloma.