中国血液净化

›› 2011, Vol. 10 ›› Issue (11): 617-620.doi: 10.3969/j.issn.1671-4091.2011.11.00

• 临床研究 • 上一篇    下一篇

血液透析患者跟骨骨量减少与大动脉僵硬的关系

孙 芳 于泽兴 刘 婧 马丽洁 沈 洋 崔太根 郭瑞军 周亦伦   

  1. 首都医科大学附属北京朝阳医院肾内科
  • 收稿日期:2011-08-26 修回日期:1900-01-01 出版日期:2011-11-12 发布日期:2011-11-12

Association of calcaneal osteopenia with arterial stiffness in hemodialysis patients

SUN Fang, YU Ze-xing, LIU Jing, MA Li-jie, SHEN Yang, CUI Tai-gen, GUO Rui-jun, ZHOU Yi-lun   

  1. Department of Nephrology, Beijing Chaoyang Hospital Affiliated to Capital University of Medical Sciences
  • Received:2011-08-26 Revised:1900-01-01 Online:2011-11-12 Published:2011-11-12

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摘要：

目的 本研究旨在探讨血液透析患者低骨量与大动脉僵硬的关系。方法 选择首都医科大学附属朝阳医院血液净化中心维持性血液透析患者41名。应用跟骨超声骨密度测定仪进行跟骨密度测定，同时测量颈总动脉僵硬度：采用日本Aloka Prosound α10型彩色多普勒超声诊断仪，高分辨血管探头(频率7.5～13MHz)，Echo-tracking技术(血管壁回声跟踪技术)测量颈总动脉僵硬度，以颈总动脉硬化参数β表示。β=[In(Ps/Pd)]/[(Ds-Dd)/Dd](Ds：血管收缩期内径，Dd：血管舒张期内径，Ps：收缩压，Pd：舒张压)。同时测定血清25-羟维生素D3、钙、磷、全段甲状旁腺素(intact parathyroid hormone，iPTH)，C-反应蛋白、白蛋白、血脂水平。结果 患者平均57.0±12.3岁。跟骨密度为-2.1±0.8，14.6%的患者存在骨质疏松，58.5%的患者存在骨量减少；Pearson相关分析显示颈总动脉硬化参数β与跟骨密度呈负相关(r=-0.453，P=0.002)；与血25-羟维生素D3呈负相关(r =-0.337，P=0.031)；与血磷呈正相关(r=0.391，P=0.022)；与平均动脉压呈正相关(r=0.298，P=0.043)；与年龄呈正相关(r =0.477，P=0.002)；而与校正后血钙、iPTH、C-反应蛋白、白蛋白、血脂水平无相关性。多元逐步回归分析显示，年龄(β=0.311，P= 0.008)、跟骨密度(β=-0.218，P=0.043)是颈总动脉硬化参数β的独立影响因素。跟骨密度与25-羟维生素D3呈正相关(r =0.315，P=0.049)；与年龄呈负相关(r =-0.381，P=0.014)；与血磷呈负相关(r =-0.323，P=0.046)，而与校正后血钙、

关键词: 血液透析, 大动脉僵硬, 骨密度, 跟骨超声定量法

Abstract:

Objective To determine the relationship between estimated calcaneal bone mineral density (BMD) and arterial stiffness in hemodialysis patients. Methods Forty one patients on maintenance hemodialysis were recruited. Estimated calcaneal BMD was measured by a calcaneal quantitative ultrasound instrument. Stiffness index β of the right common carotid artery (CCA) was measured using an ultrasonic phase-locked echo-tracking system (Prosound a10; Aloka, Japan) equipped with a high-resolution real-time 7.5-13 MHz linear scanner. Stiffness index β = [ln (Ps/Pd)]/[(Ds-Dd)/Dd], where Ps and Pd are the brachial systolic and diastolic blood pressures, respectively, and Ds and Dd are the systolic and diastolic inner diameters of CCA, respectively. Serum 25-hydroxyvitamin D3 and intact parathyroid hormone (iPTH) were detected by electrochemiluminescence. Serum calcium, phosphorus, C-reactive protein, albumin, total cholesterol, high density lipoprotein, low density lipoprotein and triglyceride were determined with standard methods. Results The mean age of the patients was 57.0±12.3 years. The mean estimated calcaneal BMD was -2.1±0.8, meaning that 14.6% of the patients had osteoporosis, and 58.5% had osteopenia. Pearson correlation analysis indicated that stiffness index β was negatively correlated with calcaneal BMD (r=-0.453, P=0.002) and 25-hydroxyvitamin D3 (r=-0.337, P=0.031), and was positively correlated with serum phosphorus (r=0.391, P=0.022), mean arterial pressure (r=0.298，P=0.043) and age (r=0.477, P=0.002), but had no correlation with serum calcium, iPTH, C-reactive protein, albumin, and lipids. Multiple stepwise regression analysis showed that age (β=0.311, P=0.008) and calcaneal BMD (β=-0.218，P=0.043) were the independent variables responsible for stiffness index β. Estimated calcaneal BMD was positively correlated with 25-hydroxyvitamin D3 (r=0.315, P=0.049) and negatively correlated with age (r=-0.381, P=0.014) and serum phosphorus (r=-0.323, P=0.046), but had no correlation with serum calcium and iPTH. Conclusion Calcaneal osteopenia is prevalent in hemodialysis patients, and it is independently correlated with carotid arterial stiffness.

Key words: Arterial stiffness, Bone mineral density, Quantitative ultrasound measurement