基于QCT分析维持性血液透析患者体质成分变化及骨密度的影响因素  

QCT-based Analysis of Changes in Body Composition and Factors Influencing Bone Mineral Density in Maintenance Hemodialysis Patients

作　　者：詹昊 陈其春[1,2] 刘田田 王龙胜 ZHAN Hao;CHEN Qi-chun;LIU Tian-tian;WANG Long-sheng(Department of Radiology,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,Anhui Province,China;Medical Imaging Research Center,Anhui Medical University,Hefei 230601,Anhui Province,China)

机构地区：[1]安徽医科大学第二附属医院放射科,安徽合肥230601 [2]安徽医科大学医学影像研究中心,安徽合肥230601

出　　处：《中国CT和MRI杂志》2023年第12期158-160,共3页Chinese Journal of CT and MRI

基　　金：中国红十字基金会2022年医学赋能-领航菁英科研项目专项基金(XM_LHJY2022_05_07)。

摘　　要：目的应用定量CT(QCT)探讨维持性血液透析患者体质成分变化及骨密度的影响因素。方法选取我院维持性血透患者156例,另选取150例与血透患者年龄性别相匹配的体检人员作为对照组。比较两组间体积骨密度(vBMD)、皮下脂肪含量(SAT)、内脏脂肪含量(VAT)、椎旁肌面积及椎旁肌脂肪面积等体质成分的差异。将血透组患者分为继发性甲状旁腺功能亢进(SHPT)和非继发性甲状旁腺功能亢进(N-SHPT)两组,并比较两组患者体质成分和骨代谢指标的差异;使用相关性分析研究两组患者vBMD与年龄、透析龄、体质成分及骨代谢指标的相关性。结果血透组VAT和椎旁肌脂肪面积均高于对照组。血透组中SHPT组vBMD高于N-SHPT组(P<0.05)。SHPT组的透析龄、血钙、iPTH、ALP高于N-SHPT组(P<0.05)。SHPT组、N-SHPT组vBMD均与年龄、椎旁肌脂肪面积呈负相关;SHPT组vBMD与iPTH、ALP呈正相关,N-SHPT组vBMD与ALP呈负相关,与iPTH无显著相关性。结论维持性血液透析患者VAT与椎旁肌脂肪面积较健康人群增加,椎旁肌脂肪含量越高vBMD越低;SHPT患者vBMD较N-SHPT患者高,可能与SHPT患者iPTH的升高有关。Objective To explore the changes in body composition and factors influencing bone mineral density in maintenance hemodialysis patients by quantitative CT(QCT).Methods 156 patients on maintenance hemodialysis dialysis were selected from our hospital,and another 150 medical examiners matching the age and sex of the hemodialysis patients were selected as a control group.The differences in body composition such as volumetric bone mineral density(vBMD),subcutaneous adipose tissue(SAT),visceral adipose tissue(VAT),paraspinal muscle area and paraspinal muscle fat area were compared between the two groups.The patients in the hemodialysis group were divided into two groups:secondary hyperparathyroidism(SHPT)and non-secondary hyperparathyroidism(N-SHPT),and the differences in body composition and bone metabolic indexes between the two groups were compared.The correlation between vBMD and age,dialysis vintage,body composition and bone metabolic indexes between the two groups was investigated using correlation analysis.Results The VAT and paraspinal muscle fat area were higher in the hemodialysis group than in the control group.In the hemodialysis group,vBMD was higher in the SHPT group than in the N-SHPT group(P<0.05).Patients in the SHPT group had higher dialysis age,blood calcium,iPTH and ALP than those in the N-SHPT group(P<0.05).vBMD was negatively correlated with age and paravertebral muscle fat area in both the SHPT and N-SHPT groups.vBMD was positively correlated with iPTH and ALP in the SHPT group,and vBMD was negatively correlated with ALP and not significantly correlated with iPTH in the N-SHPT group.Conclusion VAT and paraspinal muscle fat area were increased in maintenance hemodialysis patients compared with the healthy population,and vBMD was lower with higher paraspinal muscle fat content.vBMD was higher in SHPT patients compared with N-SHPT patients,which may be related to the elevated iPTH in SHPT patients.

关 键 词：定量CT 维持性血液透析 骨密度 肌肉脂肪浸润 继发性甲状旁腺功能亢进 

分 类 号：R582.1[医药卫生—内分泌]