中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (06): 457-462.doi: 10.3969/j.issn.1671-4091.2025.06.004

• 临床研究 • 上一篇    下一篇

维持性血液透析患者骨折发生的危险因素

刘荣丽   路金华   霍愿愿   

  1. 710021 西安，1西安市中医医院血液净化中心
  • 收稿日期:2024-09-26 修回日期:2025-03-16 出版日期:2025-06-12 发布日期:2025-06-12
  • 通讯作者: 霍愿愿 E-mail:k14kbj@163.com

Risk factors for fracture occurrence in maintenance hemodialysis (MHD) patients

LIU Rong-li, LU Jin-hua, HUO Yuan-yuan   

  1. Center of Blood Purification, Xi'an Traditional Chinese Medicine Hospital, Xi'an 710021, China
  • Received:2024-09-26 Revised:2025-03-16 Online:2025-06-12 Published:2025-06-12
  • Contact: 10021 西安，1西安市中医医院血液净化中心 E-mail:k14kbj@163.com

摘要： 目的  探索维持性血液透析(maintenance haemodialysis，MHD)患者骨折发生的影响因素。 方法  前瞻性选取西安市中医医院2020年8月—2022年12月收治的MHD患者，以7:3比例随机分为建模组与验证组，根据建模组患者是否发生骨折将建模组分为骨折组和非骨折组。多因素Logistic回归分析MHD患者发生骨折的危险因素；R软件构建预测MHD患者发生骨折的列线图模型。绘制ROC曲线评估预测患者发生骨折的列线图模型区分度；绘制校准曲线评估模型的一致性。 结果  共纳入358例患者，其中建模组251例，验证组107例。建模组38例患者发生骨折，骨折发生率为15.14%。骨折组年龄≥65岁、性别女、全段甲状旁腺激素(iPTH)≥300 ng/L占比高于非骨折组(χ2=13.014、11.765、10.158，P＜0.001、0.001、0.001)，服用活性维生素D、骨骼肌质量指数低于非骨折组(χ2/t=13.553，6.138，均P＜0.001)。骨折发生类型最多的为椎体压缩性骨折(31.58%)，其次为髋部骨折(23.68%)。多因素Logistic回归分析得出：年龄(OR=11.150，95% CI：3.790～32.086，P＜0.001)、性别(OR=5.443，95% CI：1.977～14.985，P=0.001)、iPTH(OR=31.784，95% CI：9.457～106.826，P＜0.001)是MHD患者发生骨折的危险因素，骨骼肌质量指数(OR=0.421，95% CI：0.200～0.885，P=0.022)、服用活性维生素D(OR=0.055，95% CI：0.014～0.206，P＜0.001)是保护因素。建模组AUC为0.872，H-L检验χ2=7.124，P=0.704。验证组AUC为0.924，H-L检验χ2=6.353，P=0.687。 结论  年龄、性别、iPTH是MHD患者发生骨折的危险因素，骨骼肌质量指数、服用活性维生素D是保护因素。以此构建的列线图模型可较好预测MHD患者发生骨折的风险。

关键词: 人体成分, 维持性血液透析, 骨折, 影响因素

Abstract: Objective  To investigate the influencing factors of fracture occurrence in maintenance hemodialysis (MHD) patients.  Methods  A prospective cohort of MHD patients admitted to Xi'an Hospital of Traditional Chinese Medicine from August 2020 to December 2022 was selected and randomly divided into a modeling group and a validation group in a 7:3 ratio. The modeling group was further categorized into fracture and non-fracture subgroups based on fracture occurrence. Multivariate logistic regression was used to analyze risk factors for fractures in MHD patients. A nomogram model for predicting fracture risk was constructed using R software. Receiver operating characteristic (ROC) curves were plotted to evaluate the discriminative ability of the nomogram, and calibration curves were generated to assess model consistency.  Results  A total of 358 patients were included, with 251 in the modeling group and 107 in the validation group. In the modeling group, 38 patients (15.14%) experienced fractures. The fracture group had higher proportions of patients aged ≥65 years, females, and those with intact parathyroid hormone (iPTH) ≥300 ng/L compared to the non-fracture group (χ²=13.014, 11.765, 10.158; P＜0.001, 0.001, 0.001, respectively). The fracture group also showed lower rates of active vitamin D supplementation and lower skeletal muscle mass index (χ²/t = 13.553, 6.138; both P＜0.001). The most common fracture type was vertebral compression fractures (31.58%), followed by hip fractures (23.68%). Multivariate logistic regression identified that the risk factors were age ≥65 years (OR=11.150, 95% CI: 3.790～32.086; P＜0.001), female sex (OR=5.443, 95% CI: 1.977～14.985; P=0.001), and iPTH ≥300 ng/L (OR=31.784, 95% CI: 9.457～106.826; P＜0.001); while higher skeletal muscle mass index (OR=0.421, 95% CI: 0.200～0.885; P=0.022) and active vitamin D supplementation (OR=0.055, 95% CI: 0.014～0.206; P＜0.001) were protective factors. The area under the ROC curve (AUC) was 0.872 for the modeling group (Hosmer-Lemeshow test: χ²=7.124, P=0.704) and 0.924 for the validation group (Hosmer-Lemeshow test: χ²=6.353, P=0.687), indicating good discrimination and calibration.  Conclusion  Age, female sex, and elevated iPTH are independent risk factors for fractures in MHD patients, while higher skeletal muscle mass index and active vitamin D supplementation serve as protective factors. The constructed nomogram model demonstrated good predictive performance for fracture risk in this population.

Key words: Human body composition, Maintenance hemodialysis, Fracture, Influence factor

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