中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (10): 596-599.doi: 10.3969/j.issn.1671-4091.2015.10.006

• 临床研究 • 上一篇    下一篇

维持性血液透析患者的骨密度及其相关因素分析

甘良英,杨冰,赵新菊,王梅   

  1. 北京大学人民医院肾内科(共同第一作者：杨冰)
  • 收稿日期:2015-06-08 修回日期:2015-08-17 出版日期:2015-10-12 发布日期:2015-10-12
  • 通讯作者: 王梅 wangmei1949@163.com E-mail:wangmei1949@163.com
  • 基金资助:

    北京市科学技术委员会首都临床特色应用研究支持项目，项目编号：Z131107002213122；首都卫生发展科研专项项目：2011-4022-04

Bone mineral density and it’s correlation with clinical and laboratory factors in maintenance hemodialysis patients

  • Received:2015-06-08 Revised:2015-08-17 Online:2015-10-12 Published:2015-10-12

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摘要： 目的了解维持性血液透析(MHD)患者不同部位骨密度及其相关因素。方法采用双能X线法测定MHD 患者腰椎(L1-L4)、股骨颈和非内瘘侧桡骨远端骨密度，检测其血钙(Ca)、血磷(P)、碱性磷酸酶(ALP)、C 反应蛋白(CRP)和全段甲状旁腺素(iPTH)水平。侧位腹平片方法检测患者有无腹主动脉钙化。分析MHD 患者骨密度相关因素，及腹主动脉钙化对各部位骨密度的影响。结果62 例MHD 患者(男性30 例，女性32 例)，平均年龄61.04±13.28 岁，平均透析时程27.7±29.78 月。腰椎、股骨颈和桡骨的骨质疏松发生率分别为14.5%、16.1%和38.7%，骨量减少的发生率分别是35.5%、35.5%和19.4%。腰椎、股骨颈和桡骨的T 值分别是-0.80 ± 1.65、-1.12±1.15 及-1.80±2.06，其中桡骨T 值与腰椎比下降明显(P =0.011)，桡骨骨质疏松发生率显著高于腰椎(P=0.004)和股骨(P =0.008)。本组患者中腰椎T 值女性患者明显低于男性(P =0.001)。糖尿病与非糖尿病患者间T 值无统计学差异(P＞0.05)。多元线性逐步回归分析发现，性别(β=-0.407,P＜0.01)、体质量指数(β=0.243, P＜0.05)是腰椎T 值的独立影响因素；性别(β=-0.240,P＜0.05)、年龄(β=-0.265, P＜0.01)、体质量指数(β=0.562,P＜0.01)是股骨颈T-值的独立影响因素；ALP 是桡骨T 值的独立影响因素(β=-0.329,P＜0.05)。腹主动脉钙化组不同部位T 值间相关性较无腹主动脉钙化组和全部MHD 患者弱，其中，腹主动脉钙化组腰椎T 值与桡骨T 值间无明显相关性(r=0.212,P＞0.05)。结论MHD 患者骨质疏松发生率高，其中，桡骨T 值明显降低。MHD 患者不同部位骨密度相关因素包括患者性别、年龄、体质量指数及ALP 等。MHD 患者桡骨与其它部位骨密度的差异是否提示了桡骨骨密度检测在这些患者中的意义，尚有待进一步的临床研究。

关键词: 骨密度, 双光能X线, 血液透析, 血管钙化

Abstract: Objective To observe bone mineral density (BMD) at different sites and its correlation with clinical and laboratory indices in maintenance hemodialysis (MHD) patients. Methods In this observational study, BMD at lumbar spine (L1-L4), femoral neck and radius were measured by dual energy X-ray absorptiometry
(DEXA) in MHD patients. Clinical and laboratory indices including age, body mass index (BMI), dialysis duration, albumin, corrected calcium (corrected Ca), serum phosphorus (P), calcium phosphorus product (Ca×P), C reactive protein (CRP), intact parathyroid hormone (iPTH), and alkaline phosphatase (ALP) were
investigated. Stepwise multiple linear regression analysis was used to identify risk factors for BMD. Results A total of 62 patients on MHD for 27.7+29.78 months (30 males and 32 females) were included in this study. The mean T-scores of lumbar spine, femoral neck and radius were -0.80 ±1.65, -1.12 ± 1.15, and -1.80 ± 2.06, respectively. T-score of radius was significantly lower than that of lumbar spine (P=0.011). The prevalence of osteoporosis was 14.5%, 16.1% and 38.7% and the prevalence of osteopenia was 35.5%, 35.5% and 19.4%, in lumbar spine, femoral neck and radius, respectively. Stepwise multiple linear regression analysis demonstrated that sex and BMI were the independent factors for lumbar spine T-score; sex, age and BMI were the independent factors for femoral neck T-score; and ALP was the independent factor for radius T-score. In patients with aortic calcification, lumber spine T-score had no correlation with radius T-score. Conclusion The incidence of osteoporosis is high in MHD patients. Lumbar spine and femoral neck BMD are correlated with patient’s sex, age and BMI, but radius BMD is predominantly correlated with the specific factors for CKD such as ALP. Aortic calcification may influence the measurement of lumbar BMD by DEXA.

Key words: Bone mineral density, Dual energy X-ray absorptiometry, Hemodialysis, Vascular calcification