【摘要】 目的 探讨相位角（PhA）与绝经后女性骨密度的关系及对骨质疏松（OP）的预测价值。方法 选取2022年6月至2023年4月于河南省人民医院健康管理中心体检的207例绝经女性作为研究对象。采用定量CT（QCT）测定腰椎L_1～2体积骨密度（vBMD）。根据平均骨密度，将研究对象分为骨量正常组（78例）、骨量减少组（76例）和OP组（53例）。采用生物电阻抗分析（BIA）测定研究对象的PhA和人体成分，并计算四肢骨骼肌质量指数（ASMI）。比较3组一般资料和生化指标，分析PhA与腰椎vBMD及人体成分的相关性，分析腰椎vBMD与人体成分的关系，分析腰椎vBMD的影响因素，绘制受试者工作特征（ROC）曲线，分析PhA预测绝经后女性OP发生风险的价值。结果 OP组、骨量减少组、骨量正常组年龄依次下降（P<0.05）。3组空腹血糖（FBG）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）以及碱性磷酸酶（ALP）、内脏脂肪面积（VFA）、体脂量（BFM）、体脂率（PBF）差异无统计学意义（P>0.05）。OP组的PhA、BMI、骨骼肌质量（SMM）、ASMI、基础代谢率（BMR）低于骨量减少组和骨量正常组（P<0.05）,骨量减少组与骨量正常组上述指标差异无统计学意义（P>0.05）。腰椎vBMD与BMI、SMM、ASMI、BMR呈正相关（r>0,P<0.05）,与年龄呈负相关（r<0,P<0.001）,与VFA、BFM、PBF无相关性（P>0.05）。PhA与BMI、腰椎vBMD、SMM、ASMI、BMR呈正相关（r>0,P<0.05）,与年龄呈负相关（r<0,P<0.001）,与VFA、PBF、BMF无相关性（P>0.05）。年龄、PhA、ASMI为腰椎vBMD的影响因素（P<0.05）。PhA预测绝经后女性发生OP的曲线下面积（AUC）为0.797,95%可信区间为0.733～0.861,最佳截断值是4.65°,灵敏度为73.6%,特异度为70.1%,约登指数为0.437。结论 PhA与绝经后女性腰椎vBMD、肌肉组织均有相关性，低PhA可能是绝经后女性发生OP的预测因素。更多还原

【Abstract】 Objective To explore the relationship between phase angle（PhA） and bone mineral density of postmenopausal women and its predictive value for osteoporosis（OP）.Methods From June 2022 to April 2023, 207 postmenopausal women who underwent physical examination in the Health Management Center of Henan Provincial People’s Hospital were selected as the research objects. Quantitative CT（QCT） was used to measure the lumbar L_1-2 volume bone mineral density（vBMD）. According to the average bone density, the subjects were divided into normal group（78 cases）, osteopenia group（76 cases） and OP group（53 cases）. Bioelectrical impedance analysis（BIA） was used to measure PhA and body composition of the subjects, and appendicular skeletal muscle mass index（ASMI） of limbs was calculated. The general data and biochemical indicators of the three groups were compared, and the correlation between PhA and lumbar vBMD and human body composition was analyzed. The relationship between lumbar vBMD and human body composition and the influencing factors of lumbar vBMD were analyzed. The receiver operating characteristic（ROC） curve was drawed to analyze the value of PhA in predicting the risk of OP in postmenopausal women.Results Age of OP group, osteopenia group and normal bones mass group decreased in turn（P<0.05）. There was no statistical difference in fasting blood glucose（FBG）, total cholesterol（TC）, triglyceride（TG）, high density lipoprotein cholesterol（HDL-C）, low density lipoprotein cholesterol（LDL-C）, alkaline phosphatase（ALP）, visceral fat area（VFA）, body fat mass（BFM） and percentage body fat（PBF） among the three groups（P>0.05）. The PhA, BMI, skeletal muscle mass（SMM）, ASMI and metabolic rate（BMR） in OP group were lower than those in osteopenia group and normal bone mass group（P<0.05）, and there was no statistical difference in the above indexes between the bone mass group and osteopenia group（P>0.05）. Lumbar vBMD was positively correlated with BMI, SMM, ASMI and BMR（r>0, P<0.05）, negatively correlated with age（r<0, P<0.001）, and not correlated with VFA, BFM and PBF（P>0.05）. PhA was positively correlated with BMI, lumbar vBMD, SMM, ASMI and BMR（r>0, P<0.05）, negatively correlated with age（r<0, P<0.001）, and not correlated with VFA, BFM and PBF（P>0.05）. Age, PhA and ASMI were the influencing factors of lumbar vBMD（P<0.05）. The area under curve（AUC） of PhA in predicting OP in postmenopausal women was 0.797, the 95% confidence interval was 0.733-0.861, the best cut-off value was 4.65°, the sensitivity was 73.6%, the specificity was 70.1%, and the Jordan index was 0.437.Conclusion PhA is correlated with lumber vBMD and muscle tissue in postmenopausal women, and low PhA may be a predictor of OP in postmenopausal women.更多还原