中国骨质疏松杂志

L3椎旁肌群指数与骨质疏松症的相关性研究

Study on the correlation between L3 paravertebral muscle group index and osteoporosis

DOI：10.3969/j.issn.1006-7108.2023.06.014

英文关键词:paravertebral muscle group index psoas muscle index bone mineral density osteoporosis

基金项目:江苏省老年健康科研重点课题项目（LKZ2022008；LKZ2023004）

作者	单位
王凯韬1,2 李志伟1 顾埮钜2 陈帅1 金杰1*	1. 南京中医药大学第二附属医院，江苏南京，210017 2. 南京中医药大学附属医院，江苏南京，210029

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中文摘要:

目的探讨L3椎旁肌群指数与骨密度(bone mineral density, BMD)的相关性以及如何将该指标运用于骨质疏松症的诊断。方法回顾性分析2022年2月至2022年11月在江苏省第二中医院进行腰椎椎体CT平扫+重建及骨密度测定的符合入组标准的173名患者，采集患者L3椎体层面椎旁后群肌（多裂肌和竖脊肌）及腰大肌（椎旁前肌群）面积，计算出L3水平的椎旁肌群指数、腰大肌指数(psoas muscle index，PMI)，并根据双能DXA骨密度仪测出的T值将其分为骨质疏松症组和非骨质疏松症组。采用Spearman等级相关分析椎旁肌指数、PMI与BMD的相关性。用受试者工作特征(ROC)分析椎旁肌群指数和PMI预测骨质疏松症的有效性。结果在BMD中，椎旁肌群指数与腰大肌指数均与其呈显著相关（椎旁肌群指数：L1 r= 0.595，L2 r=0.549，L3 r=0.653，L4 r=0.661，L1~4 r=0.692，股骨颈 r=0.575；腰大肌指数：L1 r= 0.551，L2 r=0.508，L3 r=0.576，L4 r=0.569，L1~4 r=0.614，股骨颈 r=0.474；P均＜0.001）。骨质疏松症患者椎旁肌群指数显著低于非骨质疏松症患者（P＜0.01）。ROC曲线分析表明，椎旁肌群指数（AUC：0.813）诊断准确率优于PMI（AUC：0.784）。总结随着年龄增长，椎旁肌群在不断改变，对于已完善腰椎CT的患者，L3椎旁肌群指数以及PMI和BMD显著相关，且椎旁肌群指数在诊断骨质疏松症方面优于PMI，故运用椎旁肌群指数可以在一定程度上辅助临床医生诊断骨质疏松症。

英文摘要:

Objective To explore the correlation between L3- paraspinal muscle group index and bone mineral density, and the application of this index in the diagnosis of osteoporosis. Methods Retrospective analysis was made on 173 patients with lumbar vertebral body CT plain scan and bone mineral density measurement from February 2022 to November 2022. The areas of posterior paraspinal muscles (multifidus and erector spinae) and psoas major muscles (anterior paraspinal muscles) at L3 vertebral level were collected, and the paraspinal muscle group index and psoas major muscle index (PMI) at L3 level were calculated. Spearman grade correlation was used to analyze the correlation between paraspinal muscle index, PMI and BMD. The effectiveness of paravertebral muscle group index and PMI in predicting osteoporosis was analyzed by ROC. Results In a single lumbar vertebra and the whole lumbar vertebra and femoral neck, the paravertebral muscle group index and psoas major index were significantly correlated with bone mineral density (paravertebral muscle group index: L1 r= 0.595, L2 r=0.549, L3 r=0.653, L4 r=0.661, L1-4 r=0.692, femoral neck r = 0.575; Psoas index: L1 r= 0.551, L2 r=0.508, L3 r=0.576, L4 r=0.569, L1-4 r=0.614, femoral neck r = 0.474; P < 0.001). The index of paravertebral muscles in osteoporosis patients was significantly lower than that in osteoporosis patients (P < 0.01). ROC curve analysis showed that the diagnostic accuracy of paravertebral muscle group index (AUC：0.813) was better than that of psoas major index (AUC：0.784). Conclusion This study shows that the paravertebral muscle groups are constantly changing with age. For patients with improved lumbar CT, the paravertebral muscle group index and psoas major index of L3 are significantly correlated with BMD, and the paravertebral muscle group index is superior to psoas major index in diagnosing osteoporosis. Therefore, using paravertebral muscle group index can help clinicians diagnose osteoporosis to a certain extent.

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