中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (12): 878-882.doi: 10.3969/j.issn.1671-4091.2022.12.004

• 临床研究 • 上一篇    下一篇

维持性血液透析患者骨密度与身体成分的相关性分析

胡小华    俞 华    邬碧波    贺云岚    俞 勇   张黎明   

  1. 200070 上海，上海市静安区闸北中心医院肾内科 
  • 收稿日期:2022-07-05 修回日期:2022-09-25 出版日期:2022-12-12 发布日期:2022-12-12
  • 通讯作者: 张黎明 E-mail:zlm198291@163.com
  • 基金资助:
    上海市静安区卫生健康委员会医学科研项目(2022MS04)

Associations between bone mineral density and body composition in patients on maintenance hemodialysis

HU Xiao-hua, YU Hua, WU Bi-bo, HE Yun-lan, YU Yong，ZHANG Li-ming   

  1. Department of Nephrology, Shanghai Jing 'an District Zhabei Central Hospital, Shanghai 200070, China
  • Received:2022-07-05 Revised:2022-09-25 Online:2022-12-12 Published:2022-12-12
  • Contact: 200070 上海，上海市静安区闸北中心医院肾内科 E-mail:zlm198291@163.com

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摘要： 目的  分析维持性血液透析患者骨密度与身体成分的关系。 方法  选择2021年3月在上海市静安区闸北中心医院规律透析病情稳定的患者124例，记录患者的年龄、性别、身高、体质量并计算体质量指数(body mass index，BMI)、原发病、透析龄等一般资料。使用人体成分分析仪测定体脂量(body fat mass,BFM)、肌肉量(soft lean mass,SLM)、去脂体质量(fat free mass,FFM)、骨骼肌含量(skeletal muscle mass,SMM)、 体脂率(percent body fat,PBF)及骨骼肌质量指数(skeletal muscle index,SMI)。采用双能X线吸收骨密度仪测定入选者桡骨近端骨密度。同时记录钙、磷、甲状旁腺激素等。对骨密度(bone mineral density,BMD)与相关因素进行统计学分析。 结果  男性维持性血液透析患者的BMD(t=8.267,P＜0.001)、SLM(Z =-7.492,P＜0.001)、FFM(Z =-7.481,P＜0.001)、SMM(Z =-7.495,P＜0.001)、SMI(t=6.560,P＜0.001)均高于女性血液透析患者，PBF(Z =-4.555,P＜0.001)、透析龄      (Z =-2.444,P =0.015)低于女性透析患者。Spearman相关分析结果显示BFM与BMD没有相关性(r=0.121,P =0.181)，SLM(r=0.652,P＜0.001)、FFM(r=0.648,P＜0.001)、SMM(r=0.650,P＜0.001)、BMI(r=0.294,P =0.001)、SMI(r=0.632,P＜0.001)与BMD呈正相关，PBF与BMD呈负相关(r=-0.209,P =0.020)。多元线性回归分析结果显示透析龄、性别、SMI是影响BMD的重要因素，身体成分中SMI与BMD呈正相关(β=0.406,P＜0.001)，BFM(β=0.084,P =0.208)、SLM(β=-0.178,P =0.400)、FFM(β=-0.192,P =0.349)、SMM    (β=-0.133,P =0.518)、BMI(β=0.081,P =0.339)、PBF(β=0.089,P =0.214)与BMD无相关性。 结论  身体成分中SMI对维持性血液透析患者骨密度有重要影响。

关键词: 血液透析, 骨密度, 身体成分

Abstract: Objective  To investigate the relationship between bone mineral density and body composition in maintenance hemodialysis patients.  Methods  124 patients with stable conditions on regular dialysis in Shanghai Jing 'an District Zhabei Central Hospital at March 2021 were selected. General data such as age, sex, height, weight and body mass index (BMI), primary disease, and dialysis vintage was recorded for each patient. The body fat mass (BFM), Soft Lean Mass (SLM), Fat Free Mass (FFM), Skeletal Muscle Mass (SMM), Percent Body Fat (PBF) and Skeletal Muscle Index (SMI) were measured using a body composition analyzer. Bone density of the proximal radius was measured using a dual-energy X-ray absorptiometry. Calcium, phosphorus, and parathyroid hormone levels were also recorded. The bone mineral density (BMD) and related factors were statistically analyzed.  Results  BMD, SLM, FFM, SMM, and SMI were significantly higher in male patients (t=8.267, P＜0.001; Z=-7.492, P＜0.001; Z=-7.481, P＜0.001; Z=-7.495, P＜0.001;         t=6.560, P＜0.001), while PBF and dialysis age were lower than in female patients (Z=-4.555, P＜0.001;     Z=-2.444, P=0.015). The results of Spearman correlation analysis showed no correlation between BFM and BMD (r=0.121, P=0.181); SLM, FFM, SMM, BMI, and SMI were positively correlated with BMD (r=0.652, P＜0.001; r=0.648, P＜0.001; r=0.650, P＜0.001; r=0.294, P=0.001; r=0.632, P＜0.001), and PBF was negatively correlated with BMD (r=-0.209,P=0.020). The results of multiple linear regression analysis showed that dialysis vintage, gender, and SMI were important factors affecting BMD, and SMI was positively correlated with BMD among body composition (β=0.406, P＜0.001), while BFM, SLM, FFM, SMM, BMI, and PBF were not correlated with BMD (β=0.084, P=0.208; β=-0.178, P=0.400; β=-0.192, P=0.349; β=-0.133, P=0.518; β=0.081, P=0.339; β=0.089, P=0.214).  Conclusion  SMI in body composition has an important effect on bone mineral density in maintenance hemodialysis patients.

Key words: Hemodialysis, Bone mineral density, Body composition

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