骨质疏松症患者MRI脂肪定量参数联合25-羟基维生素D预测骨折风险的价值

doi:10.3969/j.issn.1006-5725.2024.22.020

Abstract

Abstract:

Objective To explore the clinical application value of MRI fat quantification parameter ［vertebral bone marrow fat fraction （FF）］ combined with 25?hydroxyvitamin D ［25（OH）D］ in predicting fracture risk in patients with osteoporosis. Methods A total of 90 patients with osteoporosis who were admitted to the hospital from January 2023 to April 2024 were selected as the subjects. Among them， 50 patients with osteoporotic vertebral compression fractures were included in the fracture group， and 40 patients without fractures were included in the control group. All patients underwent the iterative decomposition of water and fat with echo asymmetry and least?squares estimation （IDEAL?IQ） method of MRI to measure the FF of each vertebra among L_1?5 and the average FF of L_1?5. Serum 25 （OH） D level was detected by electrochemiluminescence method. FF and serum 25（OH）D levels of the two groups were compared. The correlation of FF， 25（OH）D and bone mineral density （BMD） was analyzed. Multivariate logistic regression analysis was conducted to screen the risk factors for fracture in patients with osteoporosis. Receiver operating characteristic （ROC） curves were used to evaluate the predictive value of FF， 25（OH）D， and their combination for fracture in patients with osteoporosis. Results Patients in the fracture group were older than those in the control group. BMD and serum 25（OH）D level were lower than those of the control group （P < 0.05）. The FF of L₂ and average FF of L_1?5 in the fracture group were higher than those in the control group （P < 0.05）. Correlation analysis results showed that the FF of L₂ and the average FF of L_1?5 were negatively correlated with BMD （P < 0.05）， while serum 25 （OH） D level was positively correlated with BMD （P < 0.05）. Multivariate logistic regression analysis showed that age and FF of L₂ were independent risk factors for fracture in patients with osteoporosis， while BMD and 25（OH）D were protective factors （P < 0.05）. ROC curves indicated that the AUC values of FF of L2 and 25（OH）D for predicting fracture were 0.714 （95% CI： 0.606 ~ 0.822） and 0.774 （95% CI： 0.672 ~ 0.876）. The AUC of joint prediction was 0.923 （95% CI： 0.867 ~ 0.978）， which was significantly larger than that of separate prediction （P < 0.05）. Conclusions FF of L2 and serum 25（OH）D are related to fracture in patients with osteoporosis. Age and BMD are factors influencing the occurrence of fracture in patients with osteoporosis. FF of L2 and 25（OH）D have certain predictive value for fracture risk in patients with osteoporosis， and combined detection of the two can improve predictive efficiency.

Key words: osteoporosis, osteoporotic vertebral compression fracture, spinal MRI fat quantification technique, fat fraction, 25-hydroxyvitamin D

CLC Number:

R445.2

Zhen WANG,Lianjin GUO,Jiarong LIANG,Haoyi YE,Xunmeng. ZHANG. Value of MRI fat quantification parameter combined with 25⁃hydroxyvitamin D in predicting fracture risk in patients with osteoporosis[J]. The Journal of Practical Medicine, 2024, 40(22): 3238-3243.

Figures/Tables 8

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References 23

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项目	骨折组（n = 50）	对照组（n = 40）	t/χ ² 值	P值
性别			0.918	0.338
男	14（28.00）	15（37.50）
女	36（72.00）	25（62.50）
年龄（x ± s）/（岁）	68.34 ± 7.59	61.45 ± 8.41	4.078	< 0.001
BMI（x ± s）/（kg/m²）	21.89 ± 2.11	22.68 ± 2.02	1.799	0.076
吸烟史	8（16.00）	5（12.50）	0.220	0.639
饮酒史	6（12.00）	7（17.50）	0.544	0.461
基础疾病
糖尿病	17（34.00）	9（22.50）	1.431	0.232
高血压	28（56.00）	19（47.50）	0.643	0.422

项目	骨折组（n = 50）	对照组（n = 40）	t/χ ² 值	P值
TC/（mmol/L）	5.24 ± 1.24	4.89 ± 1.13	1.384	0.170
TG/（mmol/L）	1.09 ± 0.25	1.14 ± 0.31	0.847	0.399
HDL-C/（mmol/L）	1.45 ± 0.41	1.40 ± 0.36	0.606	0.546
LDL-C/（mmol/L）	3.05 ± 1.05	3.46 ± 1.02	1.864	0.066
血钙/（mmol/L）	2.26 ± 0.21	2.21 ± 0.19	1.170	0.245
血磷/（mmol/L）	1.78 ± 0.57	1.82 ± 0.53	0.341	0.734
BMD	-3.79 ± 0.95	-3.15 ± 0.57	3.752	< 0.001
25（OH）D/（ng/mL）	19.46 ± 3.19	22.73 ± 3.35	4.726	< 0.001

椎体	骨折组（n = 50）	对照组（n = 40）	t值	P值
L₁	62.04 ± 7.71	59.25 ± 7.89	1.688	0.095
L₂	66.30 ± 7.38	60.62 ± 6.33	3.861	< 0.001
L₃	64.81 ± 5.63	62.14 ± 7.68	1.902	0.060
L₄	65.08 ± 6.72	63.64 ± 7.13	0.983	0.328
L₅	66.21 ± 5.98	64.85 ± 8.16	0.912	0.364
L_1~5	64.89 ± 6.57	62.10 ± 6.21	2.051	0.043

指标	BMD
指标	r值	P值
L₂椎体FF	-0.539	< 0.001
L_1~5平均FF	-0.428	< 0.001
25（OH）D	0.697	< 0.001

变量	β	SE	Wald χ²	P值	OR（95% CI）
年龄	0.103	0.046	5.059	0.024	1.109（1.013 ~ 1.213）
BMD	-1.482	0.492	9.090	0.003	0.227（0.087 ~ 0.595）
25（OH）D	-0.433	0.119	13.247	< 0.001	0.649（0.514 ~ 0.819）
L₂椎体FF	0.166	0.050	11.222	< 0.001	1.181（1.071 ~ 1.301）
L_1~5平均FF	0.020	0.046	0.186	0.666	1.020（0.933 ~ 1.115）
常量项	-14.125	5.016	7.931	0.005	-

Value of MRI fat quantification parameter combined with 25⁃hydroxyvitamin D in predicting fracture risk in patients with osteoporosis

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指标	AUC	95%CI	P值	截断值	Younden′s指数	敏感度/%	特异度/%
L₂椎体FF	0.714	0.606 ~ 0.822	< 0.001	63.20%	0.450	70.00	75.00
25（OH）D	0.774	0.672 ~ 0.876	< 0.001	21.30 ng/mL	0.535	76.00	77.50
联合预测	0.923	0.867 ~ 0.978	< 0.001	-	0.790	94.00	85.00

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