维持性血液透析患者骨质疏松患病情况及其危险因素分析  

Analysis of prevalence and risk factors for osteoporosis in patients with maintenance hemodialysis

作　　者：王刚[1] 姜群[1] 张东亮[1] 刘文虎[1] 

机构地区：[1]首都医科大学附属北京友谊医院肾内科首都医科大学肾病学系,北京100050

出　　处：《临床和实验医学杂志》2013年第16期1277-1279,共3页Journal of Clinical and Experimental Medicine

基　　金：北京市科学技术委员会计划项目(D131100004713001);首都临床特色应用研究项目(Z121107001012138);首都卫生发展科研专项(首发2011-2002-02);北京市自然科学基金资助项目(7132091)

摘　　要：目的观察维持性血液透析(MHD)患者骨质疏松(OP)发病的情况,分析其可能的危险因素。方法选取2010年1月至2012年12月间所有在首都医科大学附属北京友谊医院血液净化中心治疗时间大于6个月的312例MHD患者,记录患者一般资料,检测患者透析前血钙、磷、尿素氮、全段甲状旁腺激素(iPTH);计算体重指数(BMI)、钙磷乘积、尿素清除指数(KT/V);应用双能X线吸收仪检测患者腰椎及股骨骨密度(BMD)。应用Logistic's回归对OP与相关因素进行相关性分析。结果随访患者中男性133例(42.6%),平均年龄(54.8±13.6)岁(25～79岁),维持透析时间(54.4±40.1)月(7～210月),钙磷乘积(50.0±8.45)mg2/dl2,iPTH(238.58±234.98)pg/ml,KT/V 1.42±0.10,腰椎BMD(0.90±0.16)g/cm2,股骨BMD(0.77±0.11)g/cm2,骨量正常32例(10.3%),骨量减少112例(35.9%),骨质疏松93例(29.8%),严重骨质疏松75例(24.0%)。骨质疏松的发生与年龄(β=0.19,RR=0.94,P=0.01)、糖尿病(β=0.16,RR=2.41,P=0.05)、维持透析时间显著相关(β=0.17,RR=1.87,P=0.02),与性别、身高、体重、BMI、既往骨折、继发性甲状旁腺机能亢进、长期使用糖皮质激素、血钙、磷、钙磷乘积、iPTH水平、KT/V无显著相关性(P>0.05)。结论 MHD患者OP的发生率高,性别、透析时间、糖尿病是其危险因素。Objective To investigate the prevalence and analyzing the potential risk factors of osteoporosis （OP） in patients treated by maintainance hemodialysis （MHD） with end - stage renal disease （ESRD） in a hemodialysis center. Methods In the hemodialysis center of Bei- jing friendship hospital, 312 patients were included into this study. All these patients had received MHD treatment for more than 6 months from January 2010 to December 2013. The clinical parameters were recorded. The level of serum calcium, phosphorus, BUN and PTH were measured and body index and KT/V were calculated. The bone mineral density（BMD） of the lumbar vertebra and the femoral bone were detected with Dual energy X -ray absorptiometry. The correlation factors of the osteoporosis were analyzed with the Logistic Regression. Results There were 133 male patients（42.6% ）. The parameters mean values were that： age （54.8 ＋ 13.6） years （25 ~ 79 years old）, MHD vintage （54.4 ＋40.1 ） month（7 -210 month）, calcium and phosphate production （50.0 ＋8.45） mg2/dl2 ,iPTH （238.58 ＋234.98） pg/ml,KT/V 1.42 ＋0.10,BMD in lumbar vertebra （0.90 ＋0.16） g/cm2 ,BMD in femoral bone （0.77 ＋0.11 ） g/cm2. The BMD results showed that bone mass was normal in 32 patients （ I0.3% ）, osteopenia in 112 patients （35.9%）, osteoporosis in 93 patients （29.8%）, and severe osteoporosis in 75 patients （24. 0% ）. Incidence of osteoporosis was markedly correlated with the age of the patients （ [3 = 0.19, RR = 0.94, P = 0.01 ）, with diabetes （ [3 = 0.16, RR = 2.41, P = 0.05 ） and with the duration of maintenance hemodialysis （ β = 0.17, RR = 1.87, P = 0.02）. Conclusion There was high inci- dence of osteoporosis in patients with MHD treatment. The incidence of osteoporosis was correlated with sex, the duration of hemodialysis and dia- betes.

关 键 词：血液透析 骨质疏松 骨密度 

分 类 号：R459.5[医药卫生—治疗学]