中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (05): 294-298.doi: 10.3969/j.issn.1671-4091.2016.05.010

• 临床研究 • 上一篇    下一篇

血液透析患者跟骨密度与周围血管疾病的相关性研究

唐子勇1,朱宁1,王悦1,张爱华1,范敏华1   

  1.  1. 北京大学第三医院肾内科
  • 收稿日期:2015-11-16 修回日期:2016-02-29 出版日期:2016-05-12 发布日期:2016-05-19
  • 通讯作者: 唐子勇 ziyong.tang@live.cn E-mail:ziyong.tang@live.cn

The association of bone mineral density and peripheral artery disease in maintenance hemodialysis patients

  • Received:2015-11-16 Revised:2016-02-29 Online:2016-05-12 Published:2016-05-19

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摘要： 目的在普通人群中骨质疏松与周围血管疾病明显相关。踝臂指数(ankle-brachial index，ABI)是周围血管疾病的诊断指标，并能很好地预测血液透析患者的心血管死亡率。本研究旨在探讨血液透析人群中ABI 与骨质疏松的相关性。方法以84 例非糖尿病稳定血液透析患者为研究对象，测定其ABI，超声骨密度仪测定其跟骨密度。统计分析ABI 与骨密度值及临床理化指标的相关性。结果据ABI 值将患者分3 组：低ABI 组(ABI＜0.9)，正常ABI 组(0.9≤ABI≤1.4)，高ABI 组(ABI＞1.4)。ABI 异常者(高或低)占总研究人群的30%。3 组间比较，患者年龄[分别(73.1±11.9)，(61.4±11.3)，(72.3±8.4)，F=9.196，P＜0.001]、血浆C 反应蛋白[分别为(30.8±75.3)mg/L,(5.3±7.1)mg/L，(48.4±101.0)mg/L，F=4.192，P=0.019]及跟骨密度值[分别为(-2.4±0.7)，(-0.9±1.0)，(-1.1±1.5)，F=14.385，P＜0.001)有明显差异。相关分析显示周围血管疾病的发生与年龄(r=0.43，P＜0.001)、血浆白蛋白(r=-0.281，P=0.010]、C 反应蛋白(r=0.298，P=0.006)、及跟骨密度值(r=-0.423，P＜0.001)明显相关。多元线性回归的结果显示，患者年龄[B= 0.013，95% CI (0.004,0.023),P=0.007]和跟骨密度值[B =-0.153,95% CI(-0.243,-0.064), P=0.001]是周围血管疾病发生的独立危险因素。结论在血液透析人群中，周围血管疾病发生率较高，骨密度降低与其发生明显相关，提示骨质疏松可能增加血液透析人群的心血管死亡率。

关键词: 血液透析, 骨密度, 踝臂指数, 周围血管疾病

Abstract: Objectives Osteoporosis is associated with peripheral artery disease (PAD) in populations, but the relationship is scarcely studied in maintenance hemodialysis (MHD) patients. The ankle-brachial index (ABI) is used to diagnose PAD and is a strong predictor for cardiovascular mortality in MHD patients. This study aims to explore the relationship between bone mineral density (BMD) and ABI in MHD patients. Methods A total of 84 non-diabetic MHD patients were included in this cross-sectional study. An ABI-form device was used to measure the patient’s ABI. Calcaneal BMD was measured by ultrasound bone densitometer. Other
clinical and laboratory data were also collected. Results Patients were grouped according to ABI: low group (ABI＜0.9), normal group (0.9≤ ABI ≤1.4), and high group (ABI＞1.4). Patients with low or high ABI were present in 30% of the patients. ANOVA analysis showed that there were significant differences among
low group, normal group and high group in age (73.1±11.9, 61.4±11.3 and 72.3±8.4 years, respectively; F= 9.196, P＜0.001), serum C reactive protein (CRP) (30.8±75.3, 5.3±7.1 and 48.4±101.0 mg/L, respectively; F= 4.192, P=0.019), and BMD (-2.4±0.7, -0.9±1.0, -1.1±1.5, respectively; F=14.385, P＜0.001). Univariate correlation showed that PAD was positively associated with age (r=0.43, P＜0.001), serum albumin (r=-0.281, P= 0.010), CRP (r=0.298, P=0.006), and BMD (r=- 0.423, P＜0.001). Multivariate regression analysis showed that age (β=0.013, 95% CI 0.004~0.023, P＜0.001) and BMD (β= -0.153, 95% CI -0.243~-0.064, P＜0.001) were the independent determinants for PAD. Conclusion The prevalence of PAD is high in MHD patients. Osteoporosis is related to PAD, suggesting that osteoporosis is a strong predictor for cardiovascular mortality in MHD patients.