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(i PTH)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。
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（i PTH）, 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.
出处
《中国血液净化》
2015年第10期596-599,共4页
Chinese Journal of Blood Purification
基金
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
关键词
骨密度
双光能X线
血液透析
血管钙化
Bone mineral density
Dual energy X-ray absorptiometry
Hemodialysis
Vascular calcification
