中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (07): 332-335.doi: 10.3969/j.issn.1671-4091.2016.07.004

• 临床研究 • 上一篇    下一篇

维持性血液透析合并继发性甲状旁腺功能亢进患者骨代谢及骨密度变化

仇方忻1,史新正1,李浩1,高爱芹1,张宁1,刘雪梅2   

  1. 1. 青岛市城阳区人民医院肾内科
    2. 青岛大学附属医院肾内科
  • 收稿日期:2015-12-21 修回日期:2016-05-08 出版日期:2016-07-12 发布日期:2016-07-12
  • 通讯作者: 刘雪梅 liuxm2004@sina.com E-mail:liuxm2004@sina.com

Bone metabolism and bone mineral density in maintenance hemodialysis patients with secondary hyperparathyroidism

  • Received:2015-12-21 Revised:2016-05-08 Online:2016-07-12 Published:2016-07-12

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摘要： 目的观察维持性血液透析(maintenance hemodialysis, MHD)合并继发性甲状旁腺功能亢进(secondary hyperparathyroidism, SHPT)患者骨代谢指标及骨密度(bone mineral density, BMD)变化。方法86 例入选MHD 合并SHPT 患者按全段甲状旁腺激素(intact parathyroid, iPTH)水平分为A(150～300pg/ml,n=23)、B(300～600 pg/ml, n=21)、C(600～1000pg/ml, n=24)、D(＞1000pg/ml, n=18)4 组；按是否合并糖尿病分为糖尿病组、非糖尿病组。测定腰椎、股骨BMD；检测iPTH、白蛋白、钙、磷、碱性磷酸酶水平。观察各组患者以上指标变化，分析iPTH 与其相关性。结果①B、C 组血磷(LSD-t=2.030，P=0.049)、L1-L4 BMD(LSD-t= 4.591, P＜0.001)和L1-L4 年轻成人T 值(LSD-t=4.813，P＜0.001)差异有统计学意义；②A、B、C、D 组随着iPTH 平的升高，左侧股骨BMD(1.07±0.18，1.00± 0.16，0.84 ± 0.15，0.78 ± 0.43，F=5.616，P=0.001)、左侧股骨年轻成人T 值(1.00 ± 0.25，0.12 ± 1.24，- 1.08 ± 1.20，- 1.05 ± 30，F=16.377，P= 0.001)、左侧股骨Wards 三角BMD(1.00 ± 0.25，0.91 ± 0.25，0.66 ± 0.09，0.62±0.03，F=6.915，P＜0.001)、左侧股骨Wards 三角年轻成人T 值(0.84± 1.68，0.18± 1.62, -1.45± 0.60，-1.75±0.19，F=14.928，P＜0.001)呈下降趋势，4 组间比较差异有统计学意义；③非糖尿病组iPTH 水平明显高于糖尿病组(t=-7.387，P＜0.001)，而左侧股骨BMD(t=2.414，P=0.018)、左侧股骨年轻成人T 值(t=5.477，P＜0.001)、左侧股骨Wards 三角BMD(t=3.252，P=0.020)、左侧股骨Wards 三角年轻成人T 值(t=7.758，P＜0.001)均明显低于糖尿病组；④相关性分析：iPTH 与ALP 呈正相关(r=0.782，P＜0.001)，与左侧股骨BMD(r=-0.532，P=0.025)、左侧股骨年轻成人T 值(r=-0.520，P=0.004)、左侧股骨Wards 三角BMD(r=-0.514，P＜0.001)、左侧股骨Wards 三角年轻成人T 值(r=-0.512，P＜0.001)呈负相关。结论MHD 合并SHPT 患者血磷可能成为反映腰椎骨代谢的标志物；iPTH 水平可预估MHD 合并SHPT患者股骨尤其是股骨Wards 三角骨代谢情况。

关键词: 维持性血液透析, 甲状旁腺功能亢进, 继发性, 骨密度

Abstract: Objective To observe the changes of bone metabolism and bone mineral density (BMD) in the maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT). Methods Eighty-six MHD patients with SHPT were enrolled in this study and were assigned according to their serum intact parathyroid (iPTH) level into 4 groups, group A (150～300 pg/ml, n=23), group B (300～600 pg/ml, n=21), group C (600～1000 pg/ml, n=24) and group D (＞1000 pg/ml, n=18), and according to the presence or absence of diabetes into diabetes group and non-diabetes group. BMD and serum albumin, calcium, phosphorus, alkaline phosphatase (ALP) and iPTH were assayed. Changes of these parameters in different groups and their relevance to iPTH levels were analyzed. Results Serum phosphorus (LSD-t=2.030, P=0.049), L1-L4 BMD (LSD-t=4.591, P＜0.001) and young adult L1-L4 T value (LSD-t=4.813, P＜0.001) were significantly different between group B and group C. iPTH was significantly higher in non-diabetes group than in diabetes group (t=-7.387, P＜0.001), while left femur BMD (t=2.414, P =0.018), young adult left femur T value (t= 5.477, P＜0.001), left femoral Wards triangle BMD (t=3.252, P=0.020) and young adult left femoral Wards triangle T value (t=7.758, P＜0.001) were significantly lower in non-diabetes group than in diabetes group ( P＜ 0.05). In groups A, B, C and D, left femur BMD (1.07±0.18, 1.00±0.16, 0.84±0.15 and 0.78±0.43 respectively; F=5.616, P =0.001), young adult left femur T value (1.00±0.25, 0.12±1.24, -1.08 ±1.20 and -1.05±30 respectively; F=16.377, P =0.001), left femoral Wards triangle BMD (1.00±0.25, 0.91±0.25, 0.66±0.09 and 0.62±0.03 respectively; F=6.915, P＜0.001) and young adult left femoral Wards triangle T value (0.84±1.68, 0.18±1.62, -1.45±0.60 and -1.75±0.19 respectively; F=14.928, P＜0.001) decreased gradually along with the increase of serum iPTH level (P＜0.01). Correlation study revealed that iPTH level was positively correlated with ALP (r=0.782, P＜0.001), and negatively correlated with left femur BMD (r=-0.532, P=0.025), young adult left femur T value (r=- 0.520, P=0.004), left femoral Wards triangle BMD (r=- 0.514, P＜0.001), and young adult left femoral Wards triangle T value (r=-0.512, P＜0.001). Conclusions In MHD patients with SHPT, hyperphosphatemia may become a marker of lumbar bone metabolism abnormalities, and serum iPTH level can be used to estimate bone metabolism of femur, especially that of femoralWards triangle.

Key words: Maintenance hemodialysis, Hyperparathyroidism, Secondary, Bone mineral density