维持性血液透析患者指骨骨密度与相关指标的关系  

Relationship between Phalangeal Bone Mineral Density and Related Indicators in Maintenance Hemodialysis Patients

作　　者：周欢 欧三桃 曾光[3] 杨舸[3] ZHOU Huan;OU Santao;ZENG Guang;YANG Ge(Department of Nephrology,Southwest Medical University Hospital,Luzhou 646000 China;Nephropathy Clinical Medical Research Center of Sichuan Province,Luzhou 646000,China;Department of Nephrology,Neijiang Second People′s Hospital,Neijiang 641100,China)

机构地区：[1]西南医科大学附属医院肾病内科,四川泸州646000 [2]四川省肾脏疾病临床医学研究中心,四川泸州646000 [3]内江市第二人民医院肾病内科,四川内江641100

出　　处：《医学综述》2020年第6期1228-1232,共5页Medical Recapitulate

摘　　要：目的探讨维持性血液透析(MHD)患者指骨骨密度与相关指标的相关性。方法选取2018年9月至2019年1月在内江市第二人民医院血液净化中心治疗的73例MHD患者为研究对象,同期进行体检的健康人30例为对照组。其中MHD患者根据是否患有骨质疏松分为骨质疏松组(31例)和非骨质疏松组(42例)。采用美国Metriscan骨密度仪进行指骨骨密度测定,采用酶联免疫吸附测定法检测所有受试者血清中Ⅰ型前胶原N端肽(PⅠNP)、Ⅰ型胶原β交联C端肽(βCTX)及1,25-二羟维生素D3[1,25(OH)2D3]的水平,同时检测MHD患者血清中钙(Ca)、磷(P)、甲状旁腺激素(PTH)、碱性磷酸酶(AKP)、高敏C反应蛋白(hs-CRP)的水平以及指骨骨密度与以上指标的相关性。结果MHD患者指骨骨密度低于对照组,骨代谢指标AKP、1,25(OH)2D3、PⅠNP较对照组明显增高(P<0.01);两组患者的βCTX比较差异无统计学意义(P>0.05);骨质疏松组患者的年龄大于非骨质疏松组[(61±12)岁比(51±13)岁],透析月龄长于非骨质疏松组[43.0(22.0,68.0)个月比19.5(12.0,37.5)个月],指骨骨密度低于非骨质疏松组(-3.55±1.08比-0.76±0.93),AKP、血磷、PTH、PⅠNP、βCTX均高于非骨质疏松组[127.0(85.0,171.0)IU/L比89.5(77.0,109.3)IU/L,(2.17±0.52)mmol/L比(1.85±0.67)mmol/L,849(473,1158)ng/L比521(369,875)ng/L,(2033±334)ng/L比(1812±334)ng/L,(224.7±37.3)ng/L比(204.0±44.0)ng/L](P<0.05或P<0.01);经相关性分析,指骨骨密度与患者年龄、透析月龄、AKP、PTH、PⅠNP呈负相关,钙、磷、1,25(OH)2D3及炎症指标hs-CRP与指骨骨密度无相关性。结论Metriscan指骨骨密度仪可用于MHD患者骨质疏松的筛查;MHD患者骨质疏松患病率高,其指骨骨密度与年龄、透析月龄、AKP、PTH、PⅠNP相关,应早期联合检测指骨密度和血清学指标,及早对MHD患者进行骨质疏松筛查,及早防治骨质疏松,预防骨折发生。Objective To investigate the correlation between phalangeal bone mineral density and related indicators in patients with maintenance hemodialysis(MHD).Methods From Sep.2018 to Jan.2019,a total of 73 MHD patients in the blood purification center of Neijiang Second People’s Hospital were included in the study and 30 healthy people during the same period were included as a control group.The MHD patients were divided into a osteoporosis group(n=31)and non-osteoporosis group(n=42)according to the existence of osteoporosis.Phalangeal bone mineral density was measured by the US Metriscan bone densitometer,enzyme-linked immunosorbent assay was used to detect serum levels of procollagen typeⅠN-terminal peptide(PⅠNP),β-cross-linked C-telopeptide of typeⅠcollagen(βCTX),and 1,25-dihydroxy vitamin D3[1,25(OH)2D3]in all subjects;the serum calcium(Ca),phosphorus(P),parathyroid hormone(PTH),alkaline phosphatase(AKP),and hypersensitive-C-reactive-protein(hs-CRP)levels were detected in MHD patients,and the correlation between BMD and the above indexes was analyzed.Results The phalangeal BMD in the MHD patients was lower than that of the control group,and the bone metabolic markers AKP,1,25(OH)2D3,and PⅠNP were significantly higher than those of the control group(P<0.01).There was no statistically signifianct difference inβCTX between the two groups(P>0.05).The age in the osteoporosis group were older than that of the non-osteoporosis group[(61±12)years vs(51±13)years],the dialysis month was longer than that of the non-osteoporosis group[43.0(22.0,68.0)months vs19.5(12.0,37.5)months],and the bone density was lower than that of that of the non-osteoporosis group(-3.55±1.08 vs-0.76±0.93),AKP,P,PTH,P1NP,βCTX were higher those of the non-osteoporosis group[127.0(85.0,171.0)IU/L vs89.5(77.0,109.3)IU/L,(2.17±0.52)mmol/L vs(1.85±0.67)mmol/L,849(473,1158)ng/L vs 521(369,875)ng/L,(2033±334)ng/L vs(1812±334)ng/L,(224.7±37.3)ng/L vs(204.0±44.0)ng/L](P<0.05 or P<0.01).Correlation analysis showed that phalangeal BMD was

关 键 词：维持性血液透析 慢性肾脏病 骨密度 骨质疏松 指骨骨密度 

分 类 号：R692.5[医药卫生—泌尿科学]