维持性血液透析患者跟骨密度及其相关因素分析

Bone mineral density and the related factors in hemodialysis patients

目的测定维持性血液透析(maintenance hemodialysis,MHD)患者跟骨的骨密度(bone mineral density,BMD)探讨骨质疏松的患病情况其相关危险因素。方法选取北京市延庆县医院血液净化中心MHD患者104例,以88例健康体检者为对照。应用跟骨超声骨密度仪进行跟骨密度测定,同时测定血清全段甲状旁腺素、钙、磷、碱性磷酸酶等,用SPSS软件进行统计分析。结果 MHD患者跟骨BMD较健康人群明显减低(-1.84±1.02 vs-0.73±1.24,P=0.045);MHD患者骨质疏松患病率为28.85%,骨量减少为59.62%;性别对BMD减少没有影响,糖尿病患者的BMD明显减少(χ2=3.931,P=0.047)。Pearson相关分析显示,随着年龄增加,患者骨密度减低,二者呈负相关(r=-0.198,P=0.036)。结论 MHD患者跟骨密度比正常人群明显降低,骨质疏松发生率高,罹患糖尿病和年龄增加都使跟骨密度减低,应积极加强预防与治疗。

Objective To explore the risk factors osteoporosis patients on maintenance hemodialysis（ MHD） by measuring bone mineral density（ BMD） of the calcaneus. Methods Quantitative ultrasound measurement of the right calcaneus was performed in104 patients on MHD in the hemodialysis center of Beijing Yanqing County Hospital and in 88 healthy controls. The serum PTH,calcium,phosphorus,and alkaline phosphatase were detected. The SPSS software was used for statistical analysis. Re sults BMD markedly reduced in MHD patients than in controls（- 1. 84 ± 1. 02 vs- 0. 73 ± 1. 24,P = 0. 045）. The incidence of osteoporosis in the diabetic MHD patients was 28. 85%,and the incidence of osteopenia was 59. 62%. Gender had no effect on the decrease of BMD. BMD decreased significantly in diabetic MHD patients（ χ^2= 3. 931,P = 0. 047）. Pearson analysis showed that BMD was negatively correlated with age（ r =- 0. 198,P = 0. 036）. Conclusion BMD of the calcaneus reduces more in MHD patients than in healthy people,and the incidence of osteoporosis is high in MHD patients. Diabetes and age are related with the decrease of BMD. The prevention and treatment should be strengthened.