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| 绝经后女性肝脏铁蓄积、骨髓脂肪与骨密度关系的多模态MRI研究 |
| Multimodal MRI study of liver iron accumulation, bone marrow adiposity, and bone mineral density in postmenopausal women |
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| DOI：10.3969/j.issn.1006-7108.2026.05.014 |
| 中文关键词: 骨质疏松症 铁蓄积 骨髓脂肪 磁共振成像 骨密度 绝经后女性 |
| 英文关键词:osteoporosis iron accumulation bone marrow fat magnetic resonance imaging bone mineral density postmenopausal women |
| 基金项目:无锡市卫生健康委“双百人才”项目（HB2023022）；无锡市卫生健康委面上项目(M202236) |
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| 中文摘要: |
| 目的 探讨绝经后女性肝脏铁水平、腰椎骨髓脂肪分数与骨密度（bone mineral density，BMD）的关系，分析铁蓄积和骨髓脂肪在骨质疏松症发生中的作用。方法 选取2019年6月至2023年8月45～80岁绝经后女性110例，根据双能X线吸收法（DXA）检测结果分为骨量正常组（49例）和骨质疏松及骨量减少组（61例）。采用3.0 T磁共振成像（MRI）扫描仪进行肝脏R2*-mapping和腰椎VIBE-Dixon序列扫描，测量肝脏R2*值和腰椎骨髓脂肪分数（PDFF）。采用Bland-Altman分析法评估测量重复性（观察者内及观察者间一致性）。采用Spearman相关分析评估BMD与肝脏R2*及腰椎骨髓PDFF的相关性。应用二元Logistic回归分析和ROC曲线分析肝脏R2*和腰椎骨髓PDFF对骨质疏松和骨量减少的预测价值，并构建中介效应模型探讨腰椎骨髓PDFF在肝脏R2*与BMD之间的中介作用。结果 Bland-Altman分析显示，观察者间肝脏R2*测量平均差值为-0.17 s-1（95%一致性限：-6.01～5.66 s-1），腰椎PDFF测量平均差值为0.24%（95%一致性限：-3.58%～4.05%）；观察者内肝脏R2*测量平均差值为-0.16 s-1（95%一致性限：-4.00～3.68 s-1），腰椎PDFF测量平均差值为0.32%（95%一致性限：-2.82%～3.45%）。骨质疏松和骨量减少组的肝脏R2*值（P＜0.001）和腰椎骨髓PDFF（P＜0.001）显著高于骨量正常组，而BMD显著低于骨量正常组（P＜0.001）。在≥65岁及＜65岁绝经女性中，BMD与肝脏R2*（P＜0.001）及腰椎骨髓PDFF（P＜0.001）均呈显著负相关。二元Logistic回归分析肝脏R2*（OR=1.066，95%CI：1.027～1.105）和腰椎骨髓PDFF（OR=1.117，95%CI：1.055～1.183）是骨质疏松症和骨量减少的独立危险因素。ROC曲线分析显示肝脏R2*和腰椎骨髓PDFF对绝经后女性骨质疏松和骨量减少的预测价值较高。中介效应分析表明，腰椎骨髓PDFF在肝脏R2*与BMD之间起显著中介作用，中介效应占比为53.6%。结论 绝经后女性肝脏铁水平和腰椎骨髓脂肪分数与BMD显著相关，且腰椎骨髓PDFF在铁蓄积与BMD之间起中介作用。因此，MRI的肝脏R2*和腰椎骨髓PDFF可作为潜在的评估绝经后女性骨质疏松和骨量减少的影像学标志物。 |
| 英文摘要: |
| Objective To investigate the relationship between liver iron content, lumbar bone marrow fat fraction, and bone mineral density (BMD) in postmenopausal women, and to analyze the role of iron accumulation and bone marrow fat in the development of osteoporosis. Methods A total of 110 postmenopausal women aged 45–80 years were enrolled from June 2019 to August 2023. Participants were divided into a normal bone mass group (n=49) and an osteopenia or osteoporosis group (n=61) based on dual-energy X-ray absorptiometry (DXA) results. Liver R2* values and lumbar bone marrow proton density fat fraction (PDFF) were measured using 3.0 T MRI with R2*-mapping and VIBE-Dixon sequences. The Bland-Altman analysis method was used to assess measurement repeatability (intra-observer and inter-observer agreement). Spearman correlation analysis was used to evaluate the associations between BMD and both liver R2* and lumbar bone marrow PDFF. Binary logistic regression and receiver operating characteristic (ROC) curve analyses were applied to assess the predictive value of liver R2* and lumbar bone marrow PDFF for osteoporosis and osteopenia. A mediating effect model was constructed to explore the potential mediating role of lumbar bone marrow PDFF in the relationship between liver R2* and BMD. Results Bland-Altman analysis showed that the inter-observer mean difference for liver R2* measurements was -0.17 s?1 (95% limits of agreement: -6.01 to 5.66 s?1), and for lumbar PDFF measurements, it was 0.24% (95% limits of agreement: -3.58% to 4.05%). The intra-observer mean difference for liver R2* measurements was -0.16 s?1 (95% limits of agreement: -4.00 to 3.68 s?1), and for lumbar PDFF measurements, it was 0.32% (95% limits of agreement: -2.82% to 3.45%). The osteopenia or osteoporosis group had significantly higher liver R2* values (P<0.001) and lumbar bone marrow PDFF (P<0.001) compared to the normal bone mass group, while BMD was significantly lower (P<0.001). In postmenopausal women aged ≥65 years and <65 years, BMD showed significant negative correlations with liver R2* (P<0.001) and lumbar bone marrow PDFF (P<0.001). Binary logistic regression identified liver R2* (OR: 1.066, 95% CI: 1.027-1.105) and lumbar bone marrow PDFF (OR: 1.117, 95% CI: 1.055-1.183) as independent risk factors for osteoporosis and osteopenia. ROC curve analysis demonstrated high predictive value of both liver R2* and lumbar bone marrow PDFF for osteoporosis/osteopenia in postmenopausal women. Mediation analysis revealed that lumbar bone marrow PDFF significantly mediated the relationship between liver R2* and BMD, accounting for 53.6% of the total effect. Conclusion Liver iron content and lumbar bone marrow fat fraction are significantly associated with BMD in postmenopausal women, and lumbar bone marrow PDFF plays a mediating role in the relationship between iron accumulation and BMD. MRI-based liver R2* and lumbar bone marrow PDFF may serve as potential imaging biomarkers for assessing osteopenia or osteoporosis in postmenopausal women. |
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