尿毒症伴重度继发性甲状旁腺功能亢进症骨密度特征分析

The characteristics of bone mineral density in patients with uremia and severe secondary hyperparathyroidism

目的研究尿毒症伴重度继发性甲状旁腺功能亢进症患者的骨密度改变特征,分析该组患者骨密度改变与临床特征之间的关系。方法回顾性总结2011年2月至2013年4月在本院接受甲状旁腺全切除联合自体前臂移植术的51例尿毒症伴重度继发性甲状旁腺功能亢进症患者的一般情况、临床特点、股骨近端和腰椎骨密度,及全切除手术所得甲状旁腺质量等数据。比较相同性别患者腰椎L1-L4之间、股骨近端不同部位之间骨密度的差异;对不同部位骨密度减少程度与上述观察变量之间的关系进行相关性分析。结果本组患者临床表现包括皮肤瘙痒、骨痛、身高缩短、面部变形和躯体变形等;血清iPTH高达2227.9±907.3 pg/ml;骨质疏松27例(52.9%),骨量减少23例(45.1%);男女性患者均显示L1至L4椎骨骨密度T值逐渐降低,男性骨密度T值L4显著低于L1(P=0.037),女性骨密度T值L4亦显著低于L1(P=0.039),男女性均显示股骨转子、股骨颈至Ward’s三角区的T值逐渐降低,男性Ward’s三角区T值显著低于股骨转子(P=0.025),女性Ward’s三角区和股骨颈T值显著低于股骨转子(P=0.009和P=0.023)。体重指数、血清白蛋白与骨密度值呈显著正相关,身高缩短、脊柱变形、胸廓变形、面部变形、血清碱性磷酸酶、血清iPTH、甲状旁腺质量与骨密度值呈显著负相关。结论骨质疏松和骨量减少广泛存在于尿毒症伴重度继发性甲状旁腺功能亢进症患者中;身体承重部位骨密度降低更严重;消瘦、低白蛋白血症、面部及躯干变形、iPTH严重升高、甲状旁腺增生程度重等因素提示骨质疏松风险增大。

Objective To investigate the characteristics of bone mineral density （ BMD ） in patients with uremia and severe secondary hyperparathyroidism （ SHPT） , and to analyze the possible relationship between the changes of BMD and clinical features. Methods Fifty one patients with uremia and severe SHPT , who underwent total parathyroidectomy with forearm autotransplantation , were enrolled in this study .The clinical data of all the patients , including the general condition , clinical feature , BMD of the proximal femur and the lumbar vertebrae , and the weight of parathyroids from surgery , were retrospectively analyzed .BMD of the lumbar vertebrae （L1-L4） and the proximal femur was compared in the patients with the same gender .The correlation analysis between the decrease of BMD and multiple variables was also performed .Results Pruritus, osteodynia, facial deformations, short statures, thoracocyllosis, spine malformations, and bowlegs were found in all or part of the patients with high serum iPTH level of 2227.9 ± 907.3pg/ml.Twenty-seven （ 52.9%） patients had osteoporosis, and 23 （ 45.1%） patients had osteopenia.BMD of L1-L4 declined gradually in men and women, while the T value of L4 was significantly lower than that of L1 （ P=0.037 in men and P=0.039 in women） .The T values of the femoral trochanter, the femoral neck, and the Ward’ s triangle also declined gradually.The T value of Ward’s triangle was significantly lower than that of the femoral trochanter （P=0.025） in men, while the T values of Ward’ s triangle and the femoral neck were significantly lower than that of the femoral trochanter （ P=0.009 and P=0.023 ） in＆amp;nbsp;women.BMI and serum albumin level were positively correlated with BMD. Shorten statures, thoracocyllosis, spine malformations, facial deformation, serum alkaline phosphatase level, serum iPTH level, and parathyroid weight were negatively correlated with BMD.Conclusion Osteoporosis and osteopenia are widely observed in patients with uremia and severe SHPT .The decrease of BMD in patients is more likely to appear in the bearing parts .Emaciation, low serum albumin levels, facial deformation, trunk malformation , high serum iPTH level , and large weight of parathyroid glands may indicate the increased risk of osteoporosis in patients with uremia and severe secondary hyperparathyroidism .