中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (11): 904-908.doi: 10.3969/j.issn.1671-4091.2025.11.006

• 临床研究 • 上一篇    下一篇

抗阻运动对维持性血液透析患者骨密度的影响研究

胡小华   郝晓萍   刘瑾瑾   王莉   贺云岚  邬碧波   

  1. 200070 上海，1上海市静安区闸北中心医院肾内科
  • 收稿日期:2025-01-13 修回日期:2025-09-06 出版日期:2025-11-12 发布日期:2025-11-12
  • 通讯作者: 邬碧波 E-mail:xts2626@163.com
  • 基金资助:
    上海市静安区卫生健康委员会医学科研项目(2022MS04)

Effect of resistance exercise on bone mineral density in maintenance hemodialysis patients

HU Xiao-hua, HAO Xiao-ping, LIU Jin-jin, WANG Li, HE Yun-lan, WU Bi-bo   

  1. Department of Nephrology, Shanghai Jing 'an District Zhabei Central Hospital, Shanghai 200070, China
  • Received:2025-01-13 Revised:2025-09-06 Online:2025-11-12 Published:2025-11-12
  • Contact: 200070 上海，1上海市静安区闸北中心医院肾内科 E-mail:xts2626@163.com

摘要： 目的  通过对维持性血液透析(maintenance hemodialysis，MHD)患者进行下肢抗阻运动康复训练，了解抗阻运动对血液透析患者骨密度的影响。 方法  选取2022年10月—2023年11月上海市静安区闸北中心医院规律透析的MHD患者作为研究对象，将患者随机分为运动康复组和对照组。对照组给予常规治疗，运动康复组在常规治疗基础上给予透析中下肢抗阻运动治疗，随访时间为6个月。比较2组的骨密度(bone mineral density，BMD)、骨骼肌质量指数(skeletal muscle index，SMI)、钙、磷、甲状旁腺激素、骨钙素(osteocalcin，OC)、I型前胶原氨基末端前肽(propeptide of type I procollagen,PINP)、β胶联降解产物(beta crosslaps,β-CTX)等指标的变化。 结果 共纳入90例患者，运动康复组和对照组各45例。研究开始前2组SMI和BMD比较差异无统计学意义(t=0.759，P=0.450；t=0.003,    P=0.997)。治疗6个月后，运动康复组SMI[(7.73±1.01)kg/m2]和BMD[(0.470±0.089)g/cm2]均较研究开始前[SMI(7.03±1.20)kg/m2,BMD(0.419±0.098)g/cm2]升高，差异有统计学意义(t=-2.615,P=0.002；t=-0.867,P=0.012)；与对照组[SMI(7.19±1.13)kg/m2,BMD(0.418±0.098)g/cm2]比较，差异有统计学意义(t=-2.390,P=0.019；t=-2.598,P=0.011)。研究开始前2组OC、β-CTX、PINP比较差异无统计学意义(Z=-0.105，P=0.292；Z=-1.126，P=0.260；Z=-0.195，P=0.846)；治疗6个月后，运动康复组的OC、β-CTX、PINP与对照组比较差异有统计学意义(Z=-3.531,P＜0.001；Z=-2.841，P=0.005；Z=-3.635，P＜0.001)。 结论  对MHD患者进行6个月的下肢抗阻运动康复训练安全、有效，可以改善患者的肌肉质量、提高骨密度、降低骨质疏松发生风险。

关键词: 抗阻运动, 血液透析, 骨密度

Abstract: Objective  To investigate the effect of resistance exercise on bone mineral density (BMD) in maintenance hemodialysis (MHD) patients by implementing lower limb resistance exercise rehabilitation training. Methods  MHD patients on regular dialysis at Shanghai Jing 'an District Zhabei Central Hospital from October 2022 to November 2023 were selected as the study subjects. Patients were randomly divided into either an exercise rehabilitation group or a control group. The control group received routine treatment, while the exercise rehabilitation group received additional intra-dialytic lower limb resistance exercise training based on routine treatment. The follow-up period was 6 months. Changes in BMD, skeletal muscle index (SMI), calcium, phosphorus, parathyroid hormone, osteocalcin (OC), N-terminal propeptide of type I procollagen (PINP), and beta C-terminal telopeptide of type I collagen (β-CTX) were compared between the two groups.  Results  A total of 90 patients were enrolled, with 45 patients in each group. Before the study, there were no statistically significant differences in SMI and BMD between the two groups (t=0.759, P=0.450; t=0.003, P=0.997). After 6 months of treatment, both SMI [(7.73 ± 1.01) kg/m²] and BMD [(0.470 ± 0.089) g/cm²] in the exercise rehabilitation group increased compared to pre-study levels [SMI(7.03±1.20)kg/m2, BMD (0.419±0.098)g/cm2], and the comparative differences were statistically significant (t=-2.615, P=0.002; t=-0.867, P=0.012). Compared to the control group during the same period (SMI 7.19±1.13 kg/m2, BMD 0.418±0.098 g/cm2)，the differences were also statistically significant (t=-2.390, P=0.019, t=-2.598, P=0.011). Before the study, there were no statistically significant differences in OC, β-CTX, and PINP between the two groups (Z=-0.105, P=0.292; Z=-1.126, P=0.260; Z=-0.195, P=0.846). After 6 months of treatment, the differences in OC, β-CTX, and PINP between the exercise rehabilitation group and the control group were statistically significant (Z=-3.531, P＜0.001; Z=-2.841, P=0.005; Z=-3.635, P＜0.001).  Conclusion   A 6-month lower limb resistance exercise rehabilitation program for MHD patients is safe and effective, improving muscle mass, increasing bone mineral density, and reducing the risk of osteoporosis.

Key words: Resistance exercise, Hemodialysis, Bone density

中图分类号: