腹膜透析患者骨密度测定与骨折风险评价

Evaluation of bone mineral density and risk factors for fractures in CAPD patients

目的观察腹膜透析患者骨密度改变及分析相关因素,为骨质疏松早期诊断和预防骨折发生提供临床依据。方法选择上海交通大学医学院附属瑞金医院肾内科84例慢性肾衰竭腹膜透析患者,以双能X线吸收(dual energy X-ray absorptiometry,DEXA)骨密度仪测定腰椎和股骨近端骨密度,同时采集其临床、生化指标及X线平片。结果 11.9%腹膜透析患者骨质疏松,36.9%骨量减少。骨质疏松多元回归分析入选变量为性别、年龄、体质量指数、尿素清除指数(Kt/V)和尿量。这些患者自腹膜透析始骨折总发生率为9.5%。进入骨折Cox回归模型是腰椎Z值和股骨颈Z值及体质量指数。结论透析不充分、低体质量指数、老年、女性、残余尿量少可能是腹膜透析患者骨质疏松重要危险因素。腰椎和股骨颈Z值可预测腹膜透析患者骨折发生,低体质量指数是腹膜透析患者骨折独立高危因素。

Objective In order to investigate the determinant factors for bone mineral density （BMD） and the risk factors for osteoporotic fractures in CAPD patients. Methods Eight-four CAPD patients were included in this study. BMD was assessed by dual energy X-ray absorptiometry （DEXA） of lumbar spine and femoral neck. Clinical data and laboratory indices as well as X-ray plain were collected. Results Osteoporosis was found in 11. 9% of the 84 patients,and osteopenia in 36.3% patients. Independent variables entering into logistic regression of osteoporosis were sex,age,BMI,Kt/V（P0.01）and daily urine output （P0.05）. The overall prevalence of fractures since the initiation of peritoneal dialysis was 9.52%. In Cox regression model,fractures were associated with lumbar spine Z-score,femoral neck Z score and BMI. Conclusions Inadequacy of dialysis,low BMI,older age,female and reduced daily urine output may be the important risk factors for osteoporosis in CAPD patients. Lumbar spine and femoral neck Z scores can predict the occurrence of fractures. Among these factors,low BMI is the most important risk factor for fractures in chronic PD patients.