目的  探讨老年血液透析(hemodialysis，HD)患者营养、炎症与骨代谢、心血管钙化的关联。 方法  回顾性选取中国人民解放军联勤保障部队第九八三医院2020年1月—2024年12月收治的老年(年龄＞60岁)HD患者作为研究组，同期选取老年体检者为对照组，比较2组血清营养指标[血白蛋白(hemodialysis，ALB)、血清前白蛋白(prealbumin，PA)、转铁蛋白(transferrin，TRF)]、炎症指标[C反应蛋白(C-reactive protein，CRP)、肿瘤坏死因子-α(tumor necrosis factor-α，TNF-α)、白细胞介素-6(interleukin-6，IL-6)]及骨代谢指标[血骨钙素(bone gla-protein，BGP)、甲状旁腺激素(parathyroid hormone，PTH)、I型前胶原氨基端前肽(N-terminal propeptide of type i procollagen，PINP)]，血红蛋白(hemoglobin，Hb)、血肌酐(serum creatinine，Scr)、血尿素氮(blood urea nitrogen，BUN)、血钙、血磷、碱性磷酸酶(alkaline phosphatase，ALP)水平；采用Pearson分析血清营养及炎症指标与骨代谢的相关性。依据心血管钙化评估将患者分为无心血管钙化组及心血管钙化组，比较2组血清指标；采用Logistic回归分析心血管钙化的危险因素，ROC曲线评估其对老年2研究组中心血管钙化组ALB、PA、TRF、BGP及血钙、Hb水平均低于无心血管钙化组(t=8.667、9.082、3.061、4.389、5.642、3.003，  P值分别为＜0.001、＜0.001、0.003、＜0.001、＜0.001、0.003)；CRP、TNF-α、IL-6、PTH、PINP、血磷、ALP、Scr、BUN水平、年龄、透析龄均高于无心血管钙化组(t=4.529、3.892、3.477、4.732、2.782、3.813、2.094、4.268、3.882、4.871、2.052，P值分别为＜0.001、＜0.001、0.001、＜0.001、0.006、＜0.001、0.038、    ＜0.001、＜0.001、＜0.001、0.042)。Pearson相关分析显示：ALB(r=0.412、-0.523、-0.385，均P＜0.001)、PA(r=0.368、-0.486、-0.356，均P＜0.001)、TRF(r=0.395、-0.508、-0.472，均P＜0.001)均与BGP呈正相关，与PTH、PINP呈负相关；CRP(r=-0.358、0.456、0.336，均P＜0.001)、TNF-α(r=-0.325、0.423、0.312，均P＜0.001)、IL-6(r=-0.342、0.445、0.328，均P＜0.001)均与BGP呈负相关，与PTH、PINP呈正相关。Logistic回归分析显示：低水平ALB(OR=0.882，95%CI：0.813～0.958，P=0.003)、低水平PA(OR=0.816，95%CI：0.676～0.985，P=0.023)、高CRP水平(OR=1.070，95%CI：1.015～1.129，P=0.012)、低血钙水平(OR=0.271，95%CI：0.080～0.921，P=0.037)、透析龄延长(OR=2.892，95%CI：1.048～7.983，P=0.041)是老年HD患者心血管钙化的独立危险因素。ROC曲线显示ALB(AUC=0.810，P＜0.001)、PA(AUC=0.824，P＜0.001)、TRF(AUC=0.608，P=0.006)、CRP(AUC=0.685，P＜0.001)、TNF-α(AUC=0.627，P=0.002)、IL-6(AUC=0.611，P=0.004)均对老年HD患者心血管钙化具有一定的诊断价值，联合诊断AUC为0.913，高于上述指标单独检测。 结论  老年HD患者营养、炎症状况与骨代谢密切相关，营养、炎症状况指标均对心血管钙化具有诊断价值，联合诊断效能更优。

Objective  To explore the association of nutrition and inflammation with bone metabolism and cardiovascular calcification in elderly patients undergoing hemodialysis (HD).  Methods Elderly patients (age>60 years) undergoing HD who were treated at the 983th Hospital of PLA Joint Logistic Support Force between January 2020 and December 2024 were retrospectively enrolled as the study group, while elderly individuals undergoing routine health examinations during the same period were enrolled as the control group. Serum nutritional indexes [albumin (ALB), prealbumin (PA), and transferrin (TRF)], inflammatory indexes [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6)], bone metabolism indexes [bone gla-protein (BGP), parathyroid hormone (PTH), and N-terminal propeptide of type I procollagen (PINP)], as well as hemoglobin (Hb), serum creatinine (Scr), blood urea nitrogen (BUN), blood calcium, blood phosphorus and alkaline phosphatase (ALP) were compared between the two groups. The correlation between serum nutritional indexes, inflammatory indexes and bone metabolism was analyzed by Pearson correlation analysis. According to the presence or absence of cardiovascular calcification, patients were divided into non-calcification group and calcification group, and serum indexes in the two groups were compared. The risk factors of cardiovascular calcification were analyzed by Logistic regression analysis, and patients’ diagnostic efficiency for cardiovascular calcification was evaluated by ROC curves.  Results  There were 195 patients in the study group and 195 individuals in the control group, respectively. The levels of ALB, PA, TRF, BGP and Hb in the study group were lower than those in the control group (t=30.709, 21.301, 14.406, 34.047, 28.805, all P＜0.001). The levels of CRP, TNF-α, IL-6, PTH, PINP, Scr and BUN in study group were higher than those in the control group (t=32.416, 28.101, 24.524, 36.802, 29.094, 52.846, 38.140, all P＜0.001). Among in the study group, the levels of ALB, PA, TRF, BGP, blood calcium and Hb in the calcification group were lower than those in the non-calcification group (t=8.667, 9.082, 3.061, 4.389, 5.642, 3.003, P＜0.001, ＜0.001, 0.003, ＜0.001, ＜0.001, 0.003), whereas the levels of CRP, TNF-α, IL-6, PTH, PINP, blood phosphorus, ALP, Scr and BUN, age and dialysis vintage were higher than those in non-calcification group (t=4.529, 3.892, 3.477, 4.732, 2.782, 3.813, 2.094, 4.268, 3.882, 4.871, 2.052; P＜0.001, ＜0.001, 0.001, ＜0.001, 0.006, ＜0.001, 0.038, ＜0.001, ＜0.001, ＜0.001, 0.042, respectively). Pearson correlation analysis showed that ALB (r=0.412, -0.523, -0.385, all P＜0.001), PA (r=0.368, -0.486, -0.356, all P＜0.001) and TRF (r=0.395, -0.508, -0.472, all P＜0.001) were positively correlated with BGP, and negatively correlated with PTH and PINP. CRP (r=-0.358, 0.456, 0.336, all P＜0.001), TNF-α (r=-0.325, 0.423, 0.312, all P＜0.001) and IL-6 (r=-0.342, 0.445, 0.328, all P＜0.001) were negatively correlated with BGP and positively correlated with PTH and PINP. Logistic regression analysis showed that lower ALB levels (OR=0.882, 95%CI: 0.813～0.958, P=0.003), lower PA levels (OR=0.816, 95%CI: 0.676～0.985, P=0.023), higher CRP levels (OR=1.070, 95%CI: 1.015～1.129, P=0.012), lower serum calcium levels (OR=0.271, 95%CI: 0.080～0.921, P=0.037) and longer dialysis vintage (OR=2.892, 95%CI: 1.048～7.983, P=0.041) were independent risk factors for cardiovascular calcification in elderly HD patients. ROC curves analysis showed that ALB (AUC=0.810, P＜0.001), PA (AUC=0.824, P＜0.001), TRF (AUC=0.608, P=0.006), CRP (AUC=0.685, P＜0.001), TNF-α (AUC=0.627, P=0.002) and IL-6 (AUC=0.611, P=0.004) had significant diagnostic value for cardiovascular calcification. The AUC of the combined model was 0.913, which was greater than the AUCs of the individual index (all P＜0.050).  Conclusion  Nutrition and inflammatory status were closely associated with bone metabolism in elderly patients undergoing HD. Nutritional and inflammatory indexes showed diagnostic value for cardiovascular calcification, and their combination provided better diagnostic performance than individual indexes.