中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (02): 121-123.doi: 10.3969/j.issn.1671-4091.2016.02.017

• 中心管理与技术 • 上一篇    下一篇

北京地区血液透析患者骨代谢指标的城乡差异

陈燊,张国娟,姜立萍,黄雯   

  1.  首都医科大学附属北京同仁医院肾内科
  • 收稿日期:2015-09-08 修回日期:2015-12-07 出版日期:2016-02-12 发布日期:2016-02-19
  • 通讯作者: 张国娟 guojuanzhang@trhos.com E-mail:guojuanzhang@hotmail.com

The difference of bone metabolism markers in maintenance hemodialysis patients from central city and countryside of Beijing

  • Received:2015-09-08 Revised:2015-12-07 Online:2016-02-12 Published:2016-02-19

RichHTML

0

PDF

191

摘要： 目的观察在相同血液透析条件下，不同生活方式和营养状态对维持性血液透析患者骨代谢的影响。方法随机选取居住于北京市区和农村维持性血液透析患者共计88 例，其中城市组48 例，农村组40 例。分别测定全段甲状旁腺素(intact parathyravd hormone,iPTH)、血钙、血磷、白蛋白、总蛋白、血清总铁结合力、血肌酐、尿素氮、总胆固醇、血红蛋白、淋巴细胞计数、尿素清除指数(Kt/V)，应用SONOST-3000 超声跟骨骨密度仪测定右脚跟骨骨密度，了解城乡不同生活方式和营养状态对维持性血液透析患者骨代谢的影响。结果农村组患者血钙(60.00% vs. 39.58% ，χ2=3.640，P=0.045)、血磷(55.00% vs. 33.33%，χ2=4.175，P= 0.034)  和iPTH 达标情况均优于城市组(P＜0.05)；平均运动时间多于城市组[(2.55 ± 0.83)h vs.(1.54 ± 0.76)h,F=35.450，P=0.000]；骨质疏松(15.00%vs.37.50% , χ2=9.697，P =0.002)和骨量减少(55% vs. 54.16%，χ2=4.099，P=0.040)发生低于城市组；运动时间与骨密度成正相关(r=0.502，P=0.000)；与营养情况相关的指标包括营养不良-炎症评分(malnutrition-inflammation score，MIS)评分以及Kt/V 方面，两组无显著差异。结论在营养状况相似的情况下，运动可能是导致维持性血液透析患者骨代谢城乡差异的主要原因。

关键词: 血液透析, 骨代谢, 骨密度, 营养状态

Abstract: Object To investigate the effect of life style and nutrition on bone metabolism in maintenance hemodialysis (MHD) patients from central city and countryside of Beijing. Method Eighty- eight MHD patients living in Beijing area were divided according to their living places into two groups, central city group (n=48) and countryside group (n=40). Serum iPTH, Ca, P, albumin (ALB), total protein (TP), total ironbinding capacity (TIBC), cretinine (Scr), BUN, total cholesterol (TC), and Hb, lymphocyte count (LC), Kt/V, and bone mineral density (BMD) were measured. Result The overall up- and to- standard rates of Ca (60.00% vs. 39.58%, χ2=3.640, P=0.045), P (55.00% vs. 33.33%, χ2=4.175, P=0.034) and iPTH (42.50% vs. 22.92%, χ2=3.857, P=0.041) were better in countryside group than in central city group. The average daily physical activity time was longer in countryside group than in central city group (P<0.05). The morbidity of osteoporosis (15.00% vs. 37.50%, χ2=9.697, P=0.002) and osteopenia (55.00% vs. 54.16%, χ2=4.099, P= 0.040) were lower in countryside group than in central city group (P<0.05). There was a positive correlation between bone density and average daily physical activity time (r=0.502, P=0.000). No significant differences
in Kt/V and malnutrition-inflammation score were found between the two groups. Conclusion Appropriate diet and physical activity are essential to maintain a normal bone metabolism in MHD patients.

Key words: Hemodialysis, Bonemetabolism, Bone density, Nutrition status