维持性血液透析患者骨密度变化特点及影响因素分析

目的探讨维持性血液透析(MHD)患者骨密度变化的特点及其影响因素,以达到早期诊断骨质疏松的目的。方法选取72例MHD患者和76例健康者(对照组),利用双能X射线(DEXA)骨密度仪检测其腰椎和髋部的骨密度值,分析MHD患者骨密度的异常情况及骨代谢生化指标的变化特点,进而探索影响骨密度的相关因素。结果 MHD患者腰椎和髋关节的骨密度明显减少,以老年女性降低最为显著,骨质疏松的发生率明显上升(P0.05)。血清检测结果显示碱性磷酸酶(AKP)、甲状旁腺素(iPTH)、磷(P)、骨钙素(OC)、1型前胶原氨基端伸展肽(P1NP)和β-1型胶原羧基末端肽(β-CTX)水平明显上升;而25-羟基维生素D(Vit D)和血钙(Ca)水平明显下降。相关性分析结果显示,骨密度与体质量指数(BMI)和血Ca呈正相关;与年龄、透析龄及AKP、OC呈负相关。结论 MHD患者易出现骨质疏松现象,其中性别、年龄、透析龄、BMI及AKP、Ca和OC均是影响骨密度的因素之一。

Analysis on clinical characteristics of bone mineral density and relevant influencing factors in maintenance hemodialysis patients

Objective To investigate the characteristics of bone mineral density (BMD) in the patients with maintenance hemodi‐alysis(M HD) and relevant influencing factors to achieve the purpose of early diagnosis of osteoporosis .Methods Seventy‐two pa‐tients undergoing MHD and 76 healthy individuals(control group) were selected .The BMD values of lumbar spine and hip were measured in all subjects by using the dual energy X‐ray absorptiometry(DEXA) .The abnormal situation of BMD and the change of serum bone metabolism indicators in the patients with M HD were analyzed .Then the related factors affecting BMD were further ex‐plored .Results Compared with healthy controls ,the average BMD of lumbar and hip joints in M HD patients was significantly de‐creased ,which in elderly women was most remarkable ,and the incidence of osteoporosis was also significantly increased (P<0 .05) . Meanwhile ,the serum detection results showed that the levels of AKP ,iPTH ,P ,osteocalcin(OC) ,procollagen 1 N‐terminal peptide (P1NP) and β‐crosslaps (β‐CTX) in the NHD patients were significantly increased ;however the levels of Vit D and Ca were markedly decreased .The correlation analysis results showed that BMD was positively correlated with BMI and blood Ca ,while neg‐atively correlated with age ,dialysis age ,serum AKP and OC levels .Conclusion M HD patients are easily to appear the osteoporosis phenomenon ,in which the gender ,age ,dialysis age ,BMI ,serum AKP ,Ca and OC are the factors affecting BMD .