中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (10): 808-812.doi: 10.3969/j.issn.1671-4091.2025.10.004

• 临床研究 • 上一篇    下一篇

维持性血液透析患者腰椎椎体骨折与基线松质骨体积骨密度的关系

陈天怡   张东亮   

  1. 102208 北京，1首都医科大学附属北京积水潭医院肾内科
  • 收稿日期:2025-03-17 修回日期:2025-06-28 出版日期:2025-10-12 发布日期:2025-10-12
  • 通讯作者: 张东亮 E-mail:zdlycy@163.com
  • 基金资助:
    北京积水潭医院院级科研基金(QN-2019-22)

Relationship between lumbar vertebral fractures and baseline trabecular volumetric bone mineral density in maintenance hemodialysis patients

CHEN Tian-yi, ZHANG Dong-liang   

  1. Department of Nephrology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 102208, China
  • Received:2025-03-17 Revised:2025-06-28 Online:2025-10-12 Published:2025-10-12
  • Contact: 102208 北京，1首都医科大学附属北京积水潭医院肾内科 E-mail:zdlycy@163.com

摘要： 目的 通过定量计算机断层(quantitative computer tomography，QCT)检查，分析维持性血液透析(maintenance hemodialysis，MHD)患者椎体骨折(vertebral fracture，VF)进展，探讨基线腰椎松质骨体积骨密度(trabecular volumetric bone mineral density，Tb.vBMD)对VF进展的重要作用。 方法 纳入2019年10月─2022年4月的44例MHD患者，收集间隔大于2年的基线和复查腰椎QCT图像，测定Tb.vBMD，并根据Genant半定量法评估VF情况，出现新发VF或基线已有VF复查提示骨折分级加重或骨折椎体数量增加则诊断为VF进展。根据VF是否进展，将患者分为VF进展组(n=17)和VF未进展组(n=27)，采用Logistic回归探讨基线腰椎Tb.vBMD及其他因素对VF进展的影响。 结果 44例患者中34例基线无VF，10例基线存在VF。VF进展组患者中11例为出现新发VF。骨折椎体个数由基线的16个增加至复查的41个。基线腰椎Tb.vBMD与VF进展呈负相关关系(OR=0.842,95% CI:0.715～0.992,      P=0.039)，基线腰椎Tb.vBMD下降10 mg/cm³，VF进展风险增加15.8%。VF进展组和VF未进展组复查腰椎Tb.vBMD较基线均显著下降(P=0.002，P=0.007)，但2组间下降程度无统计学差异。 结论 MHD患者VF进展明显，基线腰椎Tb.vBMD而非Tb.vBMD下降程度是MHD患者VF进展的独立危险因素，采用QCT方法测定的腰椎Tb.vBMD对MHD患者VF发生有一定的预测价值。

关键词: 维持性血液透析, 椎体骨折进展, 腰椎松质骨体积骨密度, 定量CT

Abstract: Objective To analyze the progression of vertebral fractures (VF) in maintenance hemodialysis (MHD) patients using quantitative computed tomography (QCT) and to explore the significant role of baseline lumbar spine trabecular volumetric bone mineral density (Tb.vBMD) in VF progression. Methods  A total of 44 MHD patients from October 2019 to April 2022 were enrolled. Baseline and follow-up lumbar QCT images with an interval of more than two years were collected. Tb.vBMD was measured, and VF was assessed using the Genant semi-quantitative method. VF progression was diagnosed if new VFs occurred, existing VFs worsened in grade, or the number of fractured vertebrae increased. Patients were divided into a VF progression group (n=17) and a non-progression group (n=27). Logistic regression was used to examine the impact of baseline lumbar Tb.vBMD and other factors on VF progression.  Results  Among the 44 patients, 34 had no VF at baseline, while 10 had existing VFs. In the VF progression group, 11 patients developed new VFs. The number of fractured vertebrae increased from 16 at baseline to 41 at follow-up. Baseline lumbar Tb.vBMD was negatively correlated with VF progression (OR=0.842, 95% CI: 0.715～0.992, P=0.039). A decrease of 10 mg/cm³ in baseline Tb.vBMD was associated with a 15.8% increase in the risk of VF progression. Both the progression and non-progression groups showed significant decreases in follow-up lumbar Tb.vBMD compared to baseline (P=0.002 and P=0.007, respectively), but the degree of decrease did not differ significantly between the two groups.  Conclusion  VF progression is significant in MHD patients. Baseline lumbar Tb.vBMD, rather than the degree of Tb.vBMD decline, is an independent risk factor for VF progression in MHD patients. Tb.vBMD measured by QCT has certain predictive value for VF occurrence in this population.

Key words: Maintenance hemodialysis, Vertebral fracture progression, Lumbar trabecular volumetric bone mineral density, Quantitative CT

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