目的 探究维持性血液透析(maintenance hemodialysis,MHD)患者骨密度(bone mineral density,BMD)与肌少症相关指标的关联及骨密度对预后的预测价值。 方法 本研究为前瞻性队列研究，纳入2024年6月1日—30日于河北医科大学第一医院血液净化中心接受治疗的MHD患者。于基线期采用腰椎定量CT测定骨密度，同步评估肌肉功能(握力、椅子站立时间、步行速度)与骨骼肌质量指数(skeletal muscle mass index,SMI)。收集患者临床资料与实验室指标，随访20个月。采用多元线性回归分析BMD的独立影响因素，COX比例风险模型评估BMD与不良临床结局的关联。 结果 共纳入125例患者，平均骨密度为(118.318±40.344)mg/cm³。多元线性回归分析显示：年龄增加(β=-1.196，95% CI：    -1.797～-0.595，P＜0.001)、椅子站立时间延长(β=-2.179，95% CI：-3.968～-0.390，P=0.017)是骨密度降低的独立危险因素；SMI是骨密度的独立保护因素(β=10.146，95% CI：3.550～16.742，P=0.003)。随访期内，骨密度为MHD患者发生心脑血管事件的独立保护因素(HR=0.990，95% CI：0.980～1.000，    P=0.042)。 结论 在MHD患者中，年龄增加与下肢肌肉功能减退是BMD降低的独立危险因素，较高的SMI是其保护因素。MHD患者的骨密度降低与心脑血管事件风险相关。

Objective  To investigate the association between bone mineral density (BMD) and sarcopenia-related indicators and evaluate the predictive value of BMD for prognosis in patients undergoing maintenance hemodialysis (MHD). Methods This prospective cohort study enrolled MHD patients who received treatment at the Hemodialysis Center of the First Hospital of Hebei Medical University from June 1 to June 30, 2024. Baseline lumbar spine BMD was measured using quantitative computed tomography. Muscle function (handgrip strength, chair stand time, gait speed) and the skeletal muscle mass index (SMI) were assessed simultaneously. Clinical data and laboratory parameters were collected, and the patients were followed prospectively for 20 months. Multiple linear regression analysis was used to identify independent factors associated with BMD, and a Cox proportional hazards model was employed to assess the association with BMD and adverse clinical outcomes.  Results  A total of 125 MHD patients were included, with a mean BMD of (118.318±40.344) mg/cm³. Multiple linear regression revealed that increased age (β=-1.196, 95% CI:-1.797～
-0.595, P＜0.001) and prolonged chair stand time (β=-2.179, 95% CI:-3.968～-0.390, P=0.017) were independent risk factors for reduced BMD, while SMI was an independent protective factor (β=10.146, 95% CI: 3.550～16.742, P=0.003). During follow-up, BMD was an independent protective factor against cardio-cerebrovascular events in MHD patients (HR=0.990, 95% CI: 0.980～1.000, P=0.042).  Conclusion In MHD patients, increased age and impaired lower limb muscle function are independent risk factors for reduced BMD, while a higher SMI is a protective factor. Lower BMD is associated with an increased risk of cardio-cerebrovascular events in MHD patients.