收稿日期: 2023-05-29
网络出版日期: 2023-11-15
Risk factors for osteoporotic vertebral compression fractures in patients with chronic hepatitis B and MRI findings of lumbar paravertebral muscles
Received date: 2023-05-29
Online published: 2023-11-15
目的 探讨慢性乙型肝炎（CHB）患者骨质疏松性椎体压缩骨折（OVCFs）的危险因素及腰椎椎旁肌肉的磁共振成像（MRI）表现。 方法 选择2019年4月至2023年4月CHB患者627例，依据T2加权MRI分为OVCFs组（n = 124）和Non-OVCFs组（n = 503）。倾向性评分匹配后分析OVCFs的危险因素；R软件建立列线图，以递归分割法建立危险分层系统；Cox模型分析MRI表现与OVCFs关联性。 结果 匹配后OVCFs组（n = 73）和Non-OVCFs组（n = 73）基线均衡（P > 0.05）。多因素分析显示，骨钙素（OST）［HR = 2.742（1.653 ~ 4.572）］、β-骨胶原交联（β-CTX）［HR = 2.590（1.984 ~ 3.391）］、1型前胶原氨基端延长肽（P1NP）［HR = 2.291（1.672 ~ 2.860）］、矢状位Cobb角［HR = 5.143（3.375 ~ 6.622）］、脊柱后凸畸形［HR = 1.772（1.491 ~ 2.095）］是OVCFs的危险因素，骨密度［HR = 0.682（0.551 ~ 0.834）］、维生素/钙补剂服用史［HR = 0.671（0.563 ~ 0.792）］、运动锻炼史［HR = 0.890（0.674 ~ 0.923）］是保护因素。列线图验证后AUC = 0.926（0.854 ~ 0.997），校准曲线平均误差为0.012。OVCFs分为极低风险组（< 105，n = 50）、低风险组（105 ≤ 评分 < 204，n = 52）、中风险组（204 ≤ 评分 < 341，n = 26）与高风险组（≥ 341，n = 18），各亚组L3/4、L4/5竖脊肌和多裂肌的肌肉净含量、脂肪浸润面积与OVCFs风险存在关联性（P趋势 < 0.05），但各亚组间不具交互性（P交互 > 0.05）。 结论 OST ≥ 15 ng/mL、β-CTX ≥ 0.5 ng/mL、P1NP ≥ 40 ng/mL、矢状位Cobb角 ≥ 55°、骨密度值＜-3.0、脊柱后凸畸形、未服用维生素/钙补剂、缺乏运动锻炼是OVCFs的危险因素。随着OVCFs风险增加，CHB患者L3/4、L4/5水平竖脊肌和多裂肌出现退行性改变。
关键词： 慢性乙型肝炎; 骨质疏松性椎体压缩骨折; 腰椎椎旁肌肉; 磁共振成像
陈科第 , 张熙明 . 慢性乙型肝炎患者骨质疏松性椎体压缩骨折的危险因素及腰椎椎旁肌肉的MRI表现[J]. 实用医学杂志, 2023 , 39(20) : 2643 -2650 . DOI: 10.3969/j.issn.1006-5725.2023.20.016
Objective To investigate the risk factors for osteoporotic vertebral compression fractures （OVCFs） in patients with chronic hepatitis B （CHB） and magnetic resonance imaging （MRI） findings of paravertebral muscles in the lumbar spine. Methods Six hundred and twenty-seven patients with CHB from April 2019 to April 2023 were selected. They were divided into OVCFs group （n = 124） and Non-OVCFs group （n = 503） based on T2-weighted MRI. Risk factors for OVCFs were analyzed after propensity score matching. R software was used to create column line plots. A risk stratification system was established by recursive segmentation.Cox model was used to analyze the association between MRI performance and OVCFs. Results The OVCFs group （n = 73） and Non-OVCFs group （n = 73） were balanced at baseline after matching （P > 0.05）. Multifactorial analysis showed that osteocalcin （OST） ［HR = 2.742 （1.653 ~ 4.572）］， β-collagen crosslinking （β-CTX） ［HR = 2.590 （1.984 ~ 3.391）］， type 1 procollagen amino-terminal extension peptide （P1NP） ［HR = 2.291 （1.672 ~ 2.860）］， sagittal Cobb's angle ［HR = 5.143 （3.375 ~ 6.622）］， and kyphosis ［HR = 1.772 （1.491 ~ 2.095）］ were risk factors for OVCFs. Bone mineral density ［HR = 0.682 （0.551 ~ 0.834）］， history of vitamin/calcium supplementation ［HR = 0.671 （0.563 ~ 0.792）］， and history of exercise ［HR = 0.890 （0.674 ~ 0.923）］ were protective factors. AUC = 0.926 （0.854 ~ 0.997） after column line plot validation. The mean error of calibration curve was 0.012. OVCFs were divided into very low risk group （< 105， n = 50）， low risk group （105 ≤ score < 204， n = 52）， medium risk group （204 ≤ score < 341， n = 26） and high risk group （≥ 341， n = 18）. There was an association between net muscle content， fat infiltration area and risk of OVCFs in L3/4， L4/5 erector spinae and multifidus muscles in each subgroup （Ptrend < 0.05）. However， there was no interaction between the subgroups （Pinteraction > 0.05）. Conclusion OST ≥ 15 ng/mL， β-CTX ≥ 0.5 ng/mL， P1NP ≥ 40 ng/mL， sagittal Cobb angle ≥ 55°， bone mineral density < -3.0， kyphosis deformity， not taking vitamin/calcium supplements， and lack of exercise are risk factors for OVCFs in CHB. With increased risk of OVCFs， CHB patients showed degenerative changes in the erector spinae and multifidus muscles at the L3/4 and L4/5 levels.
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