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目的:初步探讨慢性肾功能衰竭患者椎体骨质变化的氢质子磁共振波谱(1H-MRS)的特征及其诊断价值。方法:前瞻性的对64例经临床确诊的慢性肾功能衰竭患者行L2椎体1H-MRS采集,同时以年龄相仿的34名健康志愿者L2椎体1H-MRS作为对照组,定量分析两组感兴趣区脂肪含量(FF%)及脂水比(LWR)的差异,并分析FF%、LWR与eGFR的相关性,及作ROC曲线。结果:慢性肾功能衰竭组L2椎体平均FF%为(52.56±10.74)%,平均LWR为1.25±0.68;对照组L2椎体平均FF%为(43.24±12.19)%,平均LWR为0.85±0.44,组间差异具有统计学意义(t=-3.752,P=0.000和t=-3.512,P=0.001)。FF%与eGFR呈负相关关系(r=-0.264,P=0.035),LWR与eGFR呈负相关关系(r=-0.264,P=0.035)。FF%的ROC曲线下面积为0.706,95%CI为0.591~0.821,诊断临界值为33.29%,灵敏度为0.984,特异度为0.296;LWR的ROC曲线下面积为0.706,95%CI为0.591~0.821,诊断临界值为50.00%,灵敏度为0.984,特异度为0.296。结论:1H-MRS可无创性的检测椎体FF%及LWR,进而可以用FF%及LWR来间接的评估慢性肾功能衰竭患者的骨质变化情况。
Objective: To investigate the characteristics and diagnostic value of proton magnetic resonance spectroscopy (1H-MRS) of vertebral bone in patients with chronic renal failure. METHODS: Sixty-two patients with clinically diagnosed chronic renal failure were prospectively enrolled in the 1H-MRS with L2 vertebroplasty. At the same time, 1H-MRS of L2 vertebrae of 34 healthy volunteers were used as the control group. Quantitative analysis of the two groups (FF%) and lipid-water ratio (LWR), and analyzed the correlation between FF%, LWR and eGFR, and made the ROC curve. Results: The average FF% of L2 vertebral body in chronic renal failure group was (52.56 ± 10.74)% and the average LWR was 1.25 ± 0.68. The average FF% of L2 vertebral body in control group was (43.24 ± 12.19)% and the average LWR was 0.85 ± 0.44 The differences between groups were statistically significant (t = -3.752, P = 0.000 and t = -3.512, P = 0.001). There was a negative correlation between FF% and eGFR (r = -0.264, P = 0.035), and negative correlation between LWR and eGFR (r = -0.264, P = 0.035). The area under the ROC curve of FF% was 0.706, the 95% CI was 0.591 ~ 0.821, the diagnostic threshold was 33.29%, the sensitivity was 0.984 and the specificity was 0.296. The area under the ROC curve of LWR was 0.706 and the 95% CI was 0.591-0.821 , The diagnostic threshold was 50.00%, the sensitivity was 0.984 and the specificity was 0.296. CONCLUSION: 1H-MRS can detect FF% and LWR of vertebral body noninvasively, and then FF% and LWR can be used to indirectly evaluate bone changes in patients with chronic renal failure.