维持性血液透析患者低骨密度发生及相关因素研究  

Prevalence of low bone mineral density in patients undergoing maintenance hemodialysis and relevant factors

作　　者：常安瑾 钱莹[1] 陈晓农[1] 王伟铭[1] 张文[1] 任红[1] 陈楠[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏科,上海200025

出　　处：《上海交通大学学报（医学版）》2016年第1期59-64,共6页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家自然科学基金(81170655);"十二五"国家科技支撑计划项目(2011BAI10B06);上海市自然科学基金(14ZR1425400)~~

摘　　要：目的探讨维持性血液透析(MHD)患者低骨密度(BMD)患病率及相关影响因素。方法选取2014年4月在上海交通大学医学院附属瑞金医院透析中心接受MHD治疗的患者作为研究对象。采用DEXA骨密度仪测定腰椎及髋部BMD值,分析BMD异常的发生情况;检测血清碱性磷酸酶(AKP)、钙(Ca)、磷(P)、甲状旁腺激素(iPTH)和25-羟基维生素D[25-(OH)D_3]水平;分析BMD与临床特征(年龄、性别、体质量指数、透析龄等)和检测指标的相关性。结果共纳入144例MHD患者,男性85例,女性59例;骨质疏松和骨量减少的发生率分别为19.44%和30.56%;女性骨质疏松发生率(28.8%)明显高于男性(12.9%),差异有统计学意义(P=0.029)。相关性分析结果显示:BMD与体质量指数呈正相关,与透析龄及血清AKP、iPTH水平呈负相关。结论在积极规范的抗骨质疏松治疗前提下,MHD患者低BMD患病率仍高达50%。性别、透析龄、体质量指数及血清AKP、iPTH水平均与BMD密切相关。Objective To explore the prevalence of low bone mineral density （BMD） in patients undergoing maintenance hemodialysis （MHD） and relevant influencing factors. Methods A total of 144 patients undergoing MHD in the Hemodialysis Center of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine in April, 2014 were enrolled. The BMD values of lumbar spine and hip were measured by the dual energy X-ray absorptiometry （DEXA） . Levels of serum alkaline phosphatase （AKP）, calcium （Ca）, phosphate （P）, intact parathyroid hormone （iPTH）, and 25 hydroxy vitamin D [25 （OH） D3] were detected. Correlations among BMD, clinical characteristics [ such as gender, age, body mass index （ BMI）, and dialysis age], and examination indexes were analyzed. Results Among 144 enrolled patients undergoing MHD, 85 patients were male and 59 patients were female. The prevalence of osteoporosis and osteopenia were 19.44% and 30.56%, respectively. The prevalence of osteoporosis of females （28.8%） was higher than that of males （12.9%） and the difference was statistically significant （P=0. 029）. Results of correlation analysis showed that BMD positively correlated with BMI and negatively correlated with dialysis age and serum AKP and iPTH levels. Conclusion Based on standardized treatment of osteoporosis, the incidence of low BMD of patients undergoing MHD is still as high as 50% . Gender, dialysis age, BMI, and serum AKP and iPTH levels closely correlate with BMD.

关 键 词：骨密度 维持性血液透析 骨质疏松 

分 类 号：R459.5[医药卫生—治疗学] R580[医药卫生—临床医学]