血液透析患者跟骨密度与周围血管疾病的相关性研究  

The association of bone mineral density and peripheral artery disease in maintenance hemodialysis patients

作　　者：唐子勇[1] 朱宁[1] 王悦[1] 张爱华[1] 范敏华[1] 

机构地区：[1]北京大学第三医院肾内科,北京100191

出　　处：《中国血液净化》2016年第5期294-298,共5页Chinese Journal of Blood Purification

摘　　要：目的在普通人群中骨质疏松与周围血管疾病明显相关。踝臂指数(ankle-brachial index,ABI)是周围血管疾病的诊断指标,并能很好地预测血液透析患者的心血管死亡率。本研究旨在探讨血液透析人群中ABI与骨质疏松的相关性。方法以84例非糖尿病稳定血液透析患者为研究对象,测定其ABI,超声骨密度仪测定其跟骨密度。统计分析ABI与骨密度值及临床理化指标的相关性。结果据ABI值将患者分3组:低ABI组(ABI<0.9),正常ABI组(0.9≤ABI≤1.4),高ABI组(ABI>1.4)。ABI异常者(高或低)占总研究人群的30%。3组间比较,患者年龄[分别(73.1±11.9),(61.4±11.3),(72.3±8.4),F=9.196,P<0.001]、血浆C反应蛋白[分别为(30.8±75.3)mg/L,(5.3±7.1)mg/L,(48.4±101.0)mg/L,F=4.192,P=0.019]及跟骨密度值[分别为(-2.4±0.7),(-0.9±1.0),(-1.1±1.5),F=14.385,P<0.001)有明显差异。相关分析显示周围血管疾病的发生与年龄(r=0.43,P<0.001)、血浆白蛋白(r=-0.281,P=0.010]、C反应蛋白(r=0.298,P=0.006)、及跟骨密度值(r=-0.423,P<0.001)明显相关。多元线性回归的结果显示,患者年龄[B=0.013,95%CI(0.004,0.023),P=0.007]和跟骨密度值[B=-0.153,95%CI(-0.243,-0.064),P=0.001]是周围血管疾病发生的独立危险因素。结论在血液透析人群中,周围血管疾病发生率较高,骨密度降低与其发生明显相关,提示骨质疏松可能增加血液透析人群的心血管死亡率。Objectives Osteoporosis is associated with peripheral artery disease （PAD） in populations, but the relationship is scarcely studied in maintenance hemodialysis （MHD） patients. The ankle-hrachial index （ABI） is used to diagnose PAD and is a strong predictor for cardiovascular mortality in MHD patients. This study aims to explore the relationship between bone mineral density （BMD） and ABI in MHD patients. Meth- ods A total of 84 non-diabetic MHD patients were included in this cross-sectional study. An ABI-form device was used to measure the patient＇ s ABI. Calcaneal BMD was measured by ultrasound bone densitometer. Oth- er clinical and laboratory data were also collected. Results Patients were grouped according to ABh low group （ABI〈0.9）, normal group （0.9~〈 ABI ~〈1.4）, and high group （ABI〉 1.4）. Patients with low or high ABI were present in 30% of the patients. ANOVA analysis showed that there were significant differences among low group, normal group and high group in age （73.1：i：11.9, 61.4~11.3 and 72.3-4-8.4 years, respectively; F= 9.196, P〈0.001）, serum C reactive protein （CRP） （30.84-75.3, 5.3~7.1 and 48.4~101.0 mg/L, respectively; F=- 4.192,/9=-0.019）, and BMD （-2.4~0.7, -0.9＋1.0, -1.1-4-1.5, respectively; F=-14,385, P〈0.001）. Univariate corre- lation showed that PAD was positively associated with age （r=0.43, P〈0.001）, serum albumin （r=-0.281, P= 0.010）, CRP （r=0.298, P=0.006）, and BMD （r=- 0.423, P〈0.001）. Multivariate regression analysis showed that age （fl=0.013, 95% CI0.004-0.023, P〈0.001） and BMD （β=-0.153, 95% CI-0.243-0.064, P〈0.001） were the independent determinants for PAD. Conclusion The prevalence of PAD is high in MHD patients. Osteoporosis is related to PAD, suggesting that osteoporosis is a strong predictor for cardiovascular mortality in MHD patients.

关 键 词：血液透析 骨密度 踝臂指数 周围血管疾病 

分 类 号：R318.16[医药卫生—生物医学工程]