【摘要】目的探讨腹膜透析(peritoneal dialysis，PD)患者骨量异常的影响因素及与远期预后的关系。方法采用双能X 线法测定PD 患者骨密度，同时采集其临床、生化检验结果。记录患者骨折、死亡的时间及原因。分析PD 患者骨密度的影响因素及其与全因死亡和心血管死亡的关系。结果共74 例PD 患者纳入研究，女性38 人，平均年龄(60.9±14.1)岁，中位随访时间59.5(27.8,98.0)个月，随访期间共52 人死亡，其中26 人为心血管死亡，5 人骨折。腰椎与股骨骨量异常的诊断率存在统计学差异(χ2=17.697，P＜0.001)。低体质量指数(OR=0.666，95% CI：0.508～0.874，P=0.003)和高龄(OR=1.065，95% CI：1.007～1.126，P=0.027)是股骨骨量异常的独立危险因素。多因素COX 回归分析显示：股骨骨量异常使PD 患者心血管死亡风险增加2.58 倍(HR=3.582，95% CI：1.193～10.760，P=0.023)。结论股骨骨量异常是PD 患者心血管死亡风险的独立预测因素。
Abstract
【Abstract】Objective To investigate the determinant factors for abnormal bone mass and the relationship between abnormal bone mass and long- term outcomes in peritoneal dialysis (PD) patients. Methods Bone mineral density was assessed by dual-energy x-ray absorptiometry. Clinical data and laboratory indices of the PD patients were collected. The time and cause of fracture or death were documented. The determinant factors of bone density and the relationship between bone density and all-cause mortality and cardiovascular mortality were analyzed in the PD patients. Results A total of 74 PD (average age 60.9±14.1 years old, 38 females) patients were enrolled in the study, with a median follow-up period of 59.5 (27.8, 98.0) months. During the follow-up period, 52 patients died, of which 26 died of cardiovascular events, and 5 had fractures. The rate of abnormal bone mass diagnosed by lumbar spine examination and that by femur examination were significant different (χ2=17.697, P＜0.001). Low BMI (OR=0.666, 95% CI 0.508～0.874, P=0.003) and advanced age (OR=1.065, 95% CI 1.007～1.126, P=0.027) were the independent risk factors for femoral abnormal bone mass. Multivariate COX regression analysis revealed that abnormal femoral bone mass increased the risk of cardiovascular mortality for 2.58 times (HR=3.582, 95% CI 1.193～10.760, P=0.023). Conclusion
Abnormal femoral bone mass is an independent predictor for the risk of cardiovascular mortality in PD patients.
关键词
腹膜透析 /
骨密度 /
骨量异常 /
心血管死亡
Key words
Peritoneal dialysis /
Bone mineral density /
Abnormal bone mass /
Cardiovascular mortality
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基金
国家自然科学基金青年项目(81000296)；教育部博士点基金新教师项目(20090001120098)；北京大学人民医院研究与发展基金(RD-2013-15)
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