定量超声测定法对透析患者骨转运类型鉴别诊断的探讨  

Quantitative ultrasound applied to differentiate bone turnover in dialysis patients

作　　者：苗原溢 刘莉[1] 陈育青[1] 

机构地区：[1]北京大学第一医院肾内科,北京100034

出　　处：《中国血液净化》2017年第10期667-671,共5页Chinese Journal of Blood Purification

基　　金：首都卫生发展科研专项资金(2014-4-4073)

摘　　要：目的探讨定量超声测定法在透析患者的骨骼状态评估及骨转运类型鉴别中的价值。方法纳入42例透析患者和119例健康对照,基于去年1年平均的甲状旁腺激素(parathyroid hormone,PTH)水平把透析患者分为高PTH组和低PTH组。以超声骨密度仪测定足跟骨密度、声速、宽频超声衰减值和足跟T值,以双能X线测定髋骨密度、髋骨T值、腰椎骨密度和腰椎骨T值。结果超声骨密度仪测定的足跟骨密度与双能X线测定的髋骨密度及腰椎骨密度之间具有较强的相关性,总体的相关系数分别为r=0.461(P<0.001),r=0.438(P<0.001),在高PTH组它们之间的相关系数分别为r=0.714(P=0.002),r=0.616(P=0.011),而在低PTH组则没有相关性。声速在高PTH和低PTH组分别为(1521.345±24.004)m/s,(1539.168±26.267)m/s,2组间的差异具有显著性(t=-2.270,P=0.029);宽频超声衰减值在2组间的差异也存在显著性,分别为(70.582±12.504)dB/MHz,(82.511±12.276)dB/MHz(t=-3.072,P=0.004)。而双能X线的检测参数在2组间没有发现差异。结论定量超声测定法可能会成为一种更好的无创性检查方法,用于辅助鉴别透析患者的骨转运类型。Objective To evaluate whether quantitative ultrasound（QUS） can determine the bone status and differentiate bone turnover type in dialysis patients. Methods We recruited 42 dialysis patients and119 healthy volunteers as the study objects and attributed the dialysis patients into high serum parathyroid hormone（PTH） group and low PTH group according to the mean PTH value in the last year. They accepted QUS and dual-energy X-ray absorptiometry（DXA） examinations. QUS parameters included calcaneus bone mineral density（BMD）, T value, speed of sound（SOS） and broadband ultrasound attenuation（BUA）. DXA parameters includedBMD and T value of hip and lumbar spine. Results There were moderate correlations between calcaneus BMD by QUS and hip and lumbar spine BMD by DXA in study objects（r=0.461, P〈0.001 and r=0.438, P〈0.001, respectively） and in high PTH group（r=0.714, P=0.002 and r=0.616, P=0.011, respectively）,but not in low PTH group. SOS andBUA by QUS were significantly lower in high PTH group than in low PTH group[（1521.345 ± 24.004） m/s vs.（1539.168 ± 26.267） m/s, t=-2.270, P=0.029 for SOS and（70.582 ±12.504） dB/MHz vs.（82.511 ± 12.276） dB/MHz, t=-3.072, P=0.004 for BUA]. The parameters measured by DXA had no differences between the two groups. Conclusions Calcaneus QUS examination may be a useful technique for bone assessment, and more importantly QUS may be helpful to differentiate high turnover bone disease from low turnover bone disease in dialysis patients.

关 键 词：定量超声测定 骨转运 高转运性骨病 低转运性骨病 

分 类 号：R318.16[医药卫生—生物医学工程]