中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (10): 667-671.doi: 10.3969/j.issn.1671-4091.2017.010.007

• 临床研究 • 上一篇    下一篇

定量超声测定法对透析患者骨转运类型鉴别诊断的探讨

苗原溢1,刘莉1,陈育青1   

  1. 1. 北京大学第一医院
  • 收稿日期:2017-07-19 修回日期:2017-08-28 出版日期:2017-10-12 发布日期:2017-10-12
  • 通讯作者: 刘莉 cutewise@163.com E-mail:cutewise@163.com
  • 基金资助:

    首都卫生发展科研专项资金(2014-4-4073)

Quantitative ultrasound applied to differentiate bone turnover in dialysis patients

  • Received:2017-07-19 Revised:2017-08-28 Online:2017-10-12 Published:2017-10-12

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摘要： 目的探讨定量超声测定法在透析患者的骨骼状态评估及骨转运类型鉴别中的价值。方法纳入42 例透析患者和119 例健康对照，基于去年1 年平均的甲状旁腺激素(parathyroid hormone，PTH)水平把透析患者分为高PTH 组和低PTH 组。以超声骨密度仪测定足跟骨密度、声速、宽频超声衰减值和足跟T 值，以双能X 线测定髋骨密度、髋骨T 值、腰椎骨密度和腰椎骨T 值。结果超声骨密度仪测定的足跟骨密度与双能X 线测定的髋骨密度及腰椎骨密度之间具有较强的相关性，总体的相关系数分别为r=0.461(P＜0.001)，r=0.438(P＜0.001)，在高PTH 组它们之间的相关系数分别为r=0.714(P=0.002)，r=0.616(P=0.011)，而在低PTH 组则没有相关性。声速在高PTH 和低PTH 组分别为(1521.345±24.004)m/s，(1539.168±26.267)m/s，2 组间的差异具有显著性(t=-2.270，P=0.029)；宽频超声衰减值在2 组间的差异也存在显著性，分别为(70.582±12.504)dB/MHz，(82.511±12.276) dB/MHz(t=-3.072，P=0.004)。而双能X 线的检测参数在2 组间没有发现差异。结论定量超声测定法可能会成为一种更好的无创性检查方法，用于辅助鉴别透析患者的骨转运类型。

关键词: 定量超声测定, 骨转运, 高转运性骨病, 低转运性骨病

Abstract: Objective To evaluate whether quantitative ultrasound (QUS) can determine the bone status and differentiate bone turnover type in dialysis patients. Methods We recruited 42 dialysis patients and 119 healthy volunteers as the study objects and attributed the dialysis patients into high serum parathyroid hormone(PTH) group and low PTH group according to the mean PTH value in the last year. They accepted QUS and dual-energy X-ray absorptiometry (DXA) examinations. QUS parameters included calcaneus bone mineral density (BMD), T value, speed of sound (SOS) and broadband ultrasound attenuation (BUA). DXA parameters included BMD and T value of hip and lumbar spine. Results There were moderate correlations between calcaneus BMD by QUS and hip and lumbar spine BMD by DXA in study objects (r=0.461, P<0.001 and r=0.438, P<0.001, respectively) and in high PTH group (r=0.714, P=0.002 and r=0.616, P=0.011, respectively), but not in low PTH group. SOS and BUA by QUS were significantly lower in high PTH group than in low PTH group[ (1521.345±24.004) m/s vs. (1539.168±26.267) m/s, t=-2.270, P=0.029 for SOS and (70.582±12.504) dB/MHz vs. (82.511±12.276) dB/MHz, t=-3.072, P=0.004 for BUA]. The parameters measured by DXA had no differences between the two groups. Conclusions Calcaneus QUS examination may be a useful technique for bone assessment, and more importantly QUS may be helpful to differentiate high turnover bone disease from low turnover bone disease in dialysis patients.

Key words: Quantitative ultrasound, Bone turnover, High turnover bone disease, Low turnover bone disease