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学科主题: 影像医学与核医学
题名:
腰椎骨与肌肉、脂肪交互作用的影像学评价及对椎体骨折风险的预测
作者: 张勇
答辩日期: 2016-06-30
导师: 程晓光
专业: 影像医学与核医学
授予单位: 北京大学
授予地点: 北京大学第四临床医学院
学位: 博士
关键词: 腰椎骨 ; 肌肉 ; 脂肪 ; 交互作用 ; 评价
其他题名: Radiological evaluation of lumbar vertebrae, muscle and fat interactions and prediction for vertebral body fracture risk
分类号: R816.8
摘要:

第一部分

腰椎骨密度与肌肉、脂肪交互作用关系的定量影像学评价

 

目的:研究成年人腰椎骨、椎旁肌、腹部脂肪三者组成成分及其数量随年龄增大的变化规律,分析腰椎骨密度与肌肉、脂肪的交互作用关系,同时探讨定量影像技术在研究三者交互作用中的应用价值。

方法:研究共纳入319例研究对象(健康志愿者),其中男性148名,女性171例。以定量CT及定量MR为技术手段,测量L2-L4椎体骨密度平均值、L3椎体骨髓脂肪含量、椎旁肌密度及面积、椎旁肌脂肪含量、L2/3椎间隙水平腹部脂肪分布、肚脐水平腹部脂肪分布。将研究对象按性别及年龄各分为6组,比较不同性别各组间基线特征及其他变量的差别。对研究对象基线特征与椎骨、椎旁肌及腹部脂肪相关变量做相关分析。以骨密度值为因变量,进行可能影响其值变量的多重线性回归分析;以L3椎体脂肪含量为因变量,进行可能影响其值变量的多重线性回归分析。

结果:骨密度、椎旁肌密度及面积随年龄增大整体呈下降趋势,而椎体及椎旁肌脂肪含量、腹部脂肪面积随年龄增大整体呈上升趋势。相关分析显示在男性研究对象中,骨密度值与年龄(r=-0.650)、L3椎体骨髓脂肪含量(r=-0.737)呈强相关;在女性研究对象中,骨密度值与年龄(r=-0.784)、竖脊肌密度(r=0.525)、多裂肌密度(r=0.596)、竖脊肌脂肪含量(r=-0.635)、多裂肌脂肪含量(r=-0.645)、L3椎体骨髓脂肪含量(r=-0.822)、L2/3椎间隙水平内脏脂肪面积(r=-0.563)、肚脐水平内脏脂肪面积(r=-0.634)呈强相关。把骨密度作为因变量的多重线性回归分析显示,在男性研究对象中,回归模型包含L3椎体骨髓脂肪含量、年龄两个变量;在女性研究对象中,回归模型包含L3椎体骨髓脂肪含量、年龄、多裂肌密度三个变量。

结论:骨密度、椎旁肌密度及面积随年龄增大整体呈下降趋势,而椎体及椎旁肌脂肪含量、腹部脂肪面积随年龄增大整体呈上升趋势。腰椎骨密度降低与骨髓脂肪含量增多、年龄增大、椎旁肌密度降低相关。定量CT及MR mDixon-Quant技术在研究腰椎骨密度与肌脂交互作用关系中有着重要的应用价值。

 

第二部分

腰椎骨与肌肉、脂肪交互作用关系对椎体非暴力创伤性骨折风险预测的病例对照研究

目的:1.建立老年男性及绝经后女性包括骨密度、椎旁肌、腹部脂肪、椎体几何参数等一系列风险因子在内的预测椎体骨折风险的模型。2.探讨椎体非暴力创伤性骨折的危险因素及保护因素,及定量CT影像信息在预测椎体非暴力性骨折中的价值。

方法:采用按性别、年龄匹配的1:1配比的病例对照研究方法,共匹配52对男性和198对女性病例及对照,对可能影响椎体非暴力创伤性骨折的风险因子进行单因素及多因素logistic回归分析。风险因子的数据测量基于定量CT图像,包括测量L1-L3椎体骨密度、L3椎体中央横断面椎体面积和椎旁肌密度及面积、L2/3椎间隙水平腹部脂肪分布。以Genant半定量法评分为金标准,绘制骨密度、椎旁肌密度、椎旁肌面积诊断椎体骨折的受试者工作特征曲线,计算cutoff值。P < 0.05认为有统计学差异。

结果:单因素分析显示:在男性中,影响椎体骨折的风险因子有体重、骨密度值、椎旁肌密度及面积、L3椎体面积;在女性中,影响椎体骨折的风险因子有骨密度值、椎旁肌密度及面积、腹部脂肪分布。相关分析显示:在男性中,骨密度值与年龄、椎旁肌密度及面积相关;在女性中,骨密度值与年龄、身高、体重、椎旁肌密度及面积、腹部脂肪分布相关。多因素Logistic回归显示:在男性中,骨密度值(P=0.000)、椎旁肌密度(P=0.007)、椎旁肌面积(P=0.004)是椎体骨折的独立保护因素;在女性中,骨密度值(P=0.000)、椎旁肌密度(P=0.012)是椎体骨折的独立保护因素。在男性中,骨密度值、椎旁肌密度、椎旁肌面积诊断椎体骨折的cutoff值分别为64.16mg/cm3、32.51mg/cm3、48.00cm2;在女性中,骨密度值、椎旁肌密度诊断椎体骨折的cutoff值分别为55.58mg/cm3、32.51mg/cm3

结论:椎体非暴力创伤性骨折与骨密度、椎旁肌量及密度密切相关。在男性中骨密度值、椎旁肌密度、椎旁肌面积是椎体非暴力创伤性骨折的独立保护因素;在女性中骨密度值、椎旁肌密度是椎体骨折的独立保护因素。无论在男性或是女性中,联合骨密度及肌肉指标诊断椎体骨折的效果均好于单个指标。定量CT在预测椎体非暴力创伤性骨折中具有重要的价值。

 

英文摘要:

Part One: Quantitative radiological evaluation of lumbar vertebral bone mineral density, muscle and fat interactions

 

Objective: To study the changes in the component and its quantity of lumbar vertebrae, paravertebral muscle and abdominal fat of adults with age, and analyze the correlation between lumbar vertebral bone mineral density (BMD), muscle and fat interactions and explore the application value of quantitative radiological technique in the evaluation of the interactions between lumbar vertebrae, paravertebral muscle and abdominal fat.

Methods: 319 healthy subjects were studied in this study, including 148 males and 171 females. Quantitative Computed Tomography (QCT) and Quantitative Magnetic Resonance were used to determine the average BMD of L2-L4 lumbar vertebrae, the marrow fat content of L3 lumbar vertebra, the density, area and fat content of paravertebral muscle, abdominal fat distribution in the intervertebral space of L2/3, and abdominal fat distribution at umbilicus level. The subjects were divided into 6 groups according to their ages and genders to compare the baseline acteristics and other variables between different groups. Correlation analysis was conducted on the baseline acteristics and variables of vertebral, paravertebral muscle, abdominal fat. With BMD as the dependent variable, the multiple linear regression analysis of the variables that may affect the value of the BMD was conducted; with L3 vertebra fat content as the dependent variable, the multiple linear regression analysis of the variables that may affect the value was conducted.

Results: BMD, the density and area of paravertebral muscle were decreasing with age, while the fat contents of vertebrae and paravertebral muscle as well as the abdominal fat area were increasing with age. Analysis shows that among the male subjects, BMD was strongly correlated to age (r=-0.650) and L3 vertebra fat content (r=-0.737); among the female subjects, BMD was strongly correlated to age (r=-0.784), erector spinae density (r=0.525), multifidus muscle density (r=0.596), fat content of erector spinae (r=-0.635), fat content of multifidus muscle (r=-0.645), L3 vertebra marrow fat content (r=-0.822), visceral fat area in L2/3 intervertebral space (r=-0.563), and visceral fat area at umbilicus level (r=-0.634). The multiple linear regression analysis with BMD as the dependent variable shows that among the male subjects, the regression model includes two variables: L3 vertebra marrow fat content and age; among the female subjects, the regression model includes three variables: L3 vertebra marrow fat content, age and multifidus muscle density.

Conclusions: BMD, the density and area of paravertebral muscle were decreasing with age, while the fat contents of vertebrae and paravertebral muscle as well as the abdominal fat area were increasing with age. The decrease of lumbar vertebral density is correlated with the increase of marrow fat content, age and the decrease of paravertebral muscle density. QCT and MR mDixon-Quant have important application value in the evaluation of the interactions between lumbar vertebrae, paravertebral muscle and abdominal fat.

 

Part two: Non-violent traumatic vertebral body fracture risk prediction from lumbar vertebrae, muscle and fat interactions: a case-control study

 

Objective:1. Build the models to predict the vertebral body fracture risk of elderly males and postmenopausal females including BMD, paravertebral muscle, abdominal fat, vertebral geometrical parameters and other important risk factors.2. To explore the risk factors and protective factors of non-violent traumatic fracture of vertebral body as well as the value of QCT image information in the prediction of non-violent fracture risk of vertebral body.

Methods: With the 1:1 case-control study matched according to gender and age, univariate analysis and multiple logistic regression analysis was conducted on 52 pairs of males and 198 pairs of females as well as the risk factors that may affect the non-violent traumatic fracture of vertebral body. The data of risk factors was based on QCT image, L1-L3 vertebral BMD, vertebral size, density and area of paravertebral muscle on the central L3 axial QCT images and abdominal fat distribution in L2/3 intervertebral space were measured. With the Genant's semi-quantitative algorithm method as the golden standard for fracture, draw the receiver operating acteristic curve of BMD, paravertebral muscle density and area to diagnose vertebral fracture, and calculate the cutoff value. P value < 0.05 was considered statistically significant.

Results: The univariate analysis showed that among the males, the risk factors affecting vertebral fracture include weight, BMD, density and area of paravertebral muscle and L3 vertebral area; among the females, the risk factors affecting vertebral fracture include BMD, density and area of paravertebral muscle and abdominal fat distribution. The correlation analysis showed that the BMD was correlated with age, density and area of paravertebral muscle among males; the BMD wascorrelated with age, height, weight, density and area of paravertebral muscle and abdominal fat distribution. The multiple logistic regression analysis showed that among the males, the BMD (P=0.000), paravertebral muscle density (P=0.007) and paravertebral muscle area (P=0.004) were the independent protective factors of vertebral fracture; among the females, the BMD (P=0.000) and paravertebral muscle density (P=0.012) were the independent protective factors of vertebral fracture. Among the males, the cutoff values of vertebral fracture diagnosis with BMD, paravertebral muscle density and paravertebral muscle area were respectively 64.16mg/cm3, 32.51mg/cm3 and 48.00cm2; among the females, the cutoff values of vertebral fracture diagnosis with BMD and paravertebral muscle density were respectively 55.58mg/cm3 and 32.51mg/cm3.

Conclusions: The non-violent traumatic fracture of vertebral body is correlated with BMD, paravertebral muscle quantity and density. Among the males, BMD, paravertebral muscle density and area are the independent protective factors of vertebral body fracture; among the females, BMD and paravertebral muscle density are the independent protective factors of vertebral body fracture. Among both the males and females, the diagnosis effect of combined BMD and muscle indexes is better than that of single index. Therefore, QCT has an important value in the prediction of non-violent traumatic fracture of vertebral body.

 

语种: 中文
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/124764
Appears in Collections:北京大学第四临床医学院_学位论文

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作者单位: 北京大学第四临床医学院

Recommended Citation:
张勇. 腰椎骨与肌肉、脂肪交互作用的影像学评价及对椎体骨折风险的预测[D]. 北京大学第四临床医学院. 北京大学. 2016.
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