459例维持性血液透析患者骨密度相关因素的研究  

Research on bone density related factors in 459 maintenance hemodialysis patients

作　　者：刘红[1] 常明[1] 刘书馨[1] 高建亚 

机构地区：[1]大连市中心医院肾内科,大连116033

出　　处：《临床肾脏病杂志》2016年第2期87-91,共5页Journal Of Clinical Nephrology

基　　金：大连市卫生局科研基金(NO.20120510)

摘　　要：目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者跟骨骨密度(bone mineral density,BMD)与透析相关的临床因素及骨代谢、生化指标之间的关系。方法选取2014年6月至2015年2月大连市中心医院MHD患者459例。记录MHD患者性别、年龄、原发病、透析时间、透析治疗方式、使用肝素类型、心血管疾病、主动脉钙化情况。同期检测患者治疗前血钙、血磷、碱性磷酸酶(alkaline phosphatase,ALP)、甲状旁腺素(parathyroid hormone,PTH)、血白蛋白(albumin,Alb)、血红蛋白(hemoglobin,Hb)、碳酸氢根(HCO_3^(2-))水平,计算尿素清除指数(Kt/V)情况。使用美国Sahara超声骨密度仪进行跟骨BMD测量。结果低通量透析患者较高通量透析患者BMD降低(P<0.05),有主动脉钙化患者较无主动脉钙化患者BMD降低(P<0.01);不同透析时间之间、糖尿病与非糖尿病之间BMD无明显差异。低分子肝素组与普通肝素组BMD比较无明显统计学差异。心血管疾病组与无心血管疾病组之间BMD无统计学差异。血磷及A1b水平与BMD呈正相关(r=0.136,P<0.01;r=0.148,P<0.01)。女性、年龄≥60岁、低通量透析、有主动脉钙化的患者更易发生骨质疏松,Logistic回归分析显示年龄≥60岁(OR=0.92,95%CI 0.892-0.949)、女性(OR=0.376,95%CI 0.203-0.697)、主动脉钙化(OR=0.01,95%CI:0.000-0.213)是MHD患者骨质疏松的独立危险因素。结论透析治疗方式、血管钙化可能是影响骨密度的因素,血磷和白蛋白水平在骨的生物学功能和骨的矿化过程可能发挥了重要的作用;高龄、女性、主动脉钙化可能是MHD患者骨质疏松的独立危险因素。Objective This study aimed to explore the relation between calcaneal bone mineral density（BMD） and bone metabolism.biochemical indicators.dialysis related factor in maintenance hemodialysis （MHD） patients. Methods From June 2014 to February 2015 in Dalian Central Hospital MHD patients with 459 cases. MHD patients recorded sex, age, primary disease, duration of dialysis, differences of dialysis modality, the use of heparin type, cardiovascular events, aortic calcification. Collecting blood biochemical indicators： calcium （Ca）, serum phosphorus （P）, parathyroid hormone （PTH）, alkaline phosphatase （ALP）, albumin （Alb）, hemoglobin （Hb）, bicarbonate （HCO3^2-）, and calculating Kt/v. Using US Hologic Model Sahara ultrasound BMD instrument for measuring calcaneal bone mineral density. Results BMD in Low flux dialysis were lower than high flux dialysis （HFD） group （P^0. 05）. BMD of aortic calcification group were lower than the group that did not occur aortic calcification （P^0. 01 ）. BMD was no significant difference between primary disease for diabetic nephropathy and non diabetic nephropathy, also for different duration of dialysis. BMD has no statistically significant （P〈0. 05） between use of low molecular weight heparin and ordinary heparin group , also for clinical cardiovascular events group and nonclinical cardiovascular events group. Serum Phosphorus and ALB were positively correlated with BMD （r = 0. 136, P〈0. 01; r = 0. 148, P〈 0. 01）. Lower BMD were more likely to happen in MHD with female , more than 60 years old , low flux dialysis and aortic calcification. Logistic regression analysis showed that female（OR = 0. 376,95 CI：0. 203-0. 697）, more than 60 years old（OR = 0. 92,95%CI： 0. 892-0. 949） ,aortic calcification（OR = 0. 01,95%CI：0. 000-0. 213） were likely independent risk factors for osteoporosis. Conclusions Dialysis mode, vascular calcification were probably the influence factors of BMD. Serum Phosphorus and ALB maybe play

关 键 词：维持性血液透析 骨密度 骨质疏松 

分 类 号：R459.5[医药卫生—治疗学]