慢性肾脏病3～5期非透析患者合并骨密度低下情况及危险因素分析

Incidence and Risk Factors of Low Bone Mineral Density in Non- dialysis Patients with Stages 3-5 Chronic Kidney Disease

目的 分析慢性肾脏病（CKD）3 ～5期非透析患者合并骨密度（BMD）低下的发生情况及其相关的危险因素,为早期干预CKD伴骨密度低下提供理论依据.方法 入选CKD3～5期门诊非透析的患者126例,记录临床特征,实验室指标,并行双能X线吸收骨密度测量法测定腰椎及股骨BMD.根据BMD值将入选患者分为BMD低下组和BMD正常组,比较两组患者的年龄、性别、体重指数（BMI）、是否糖尿病、估计肾小球率过滤（eGFR）、血清钙（Ca）、磷（P）、钙磷乘积（Ca×P）全段甲状旁腺素（iPTH）、碱性磷酸酶（AKP）及25羟维生素D3[25-（OH）-VitD3]的差异,对可能影响骨密度的危险因素进行单因素分析和Logistic多因素回归分析.结果 CKD 3～5期患者合并骨密度低下的发生率高达50％,股骨骨密度随肾功能损害进展下降明显;骨密度低下的发生与性别（OR=2.668,P=O.015）、eGFR（OR=0.860,P=O.043）、iPTH（OR=1.015,P=0.020）、25-（OH）-VitD3（OR=0.824,P=0.001）显著相关,与年龄、BMI、是否糖尿病、Ca、P、Ca×P、AKP无显著相关性（P＞0.05）.结论CKD3-5期非透析患者合并骨密度低下的发生率高,绝经后老年女性、肾功能损伤越重、血清高iPTH和低25-（OH）-VitD3水平的患者是其中高危人群.

Objective To analyze the incidence of and risk factors for low bone mineral density（BMD） in non-dialysis patients with stages 3-5 chronic kidney disease（CKD）.Methods Non-dialyzed outpatients with stages 3-5 CKD（n =126） were enrolled and received lumbar and femoral BMD tests using dual-energy X-ray absorptiometry.The patients were divided into low and normal BMD groups,and the age,sex,body mass index （BMI）,diabetes mellitus （DM）,estimated glomerular filtration rate （eGFR）,and the serum levels of Ca,P,Ca × P,intact parathyroid hormone （iPTH）,alkaline phosphatase （AKP） and 25-hydroxyvitamin D [25-（OH）-VitD3] were compared between groups.The results were analyzed using logistic regression analysis to identify the risk factors for low BMD.Results Among the 126 enrolled patients,63 had low BMD（50％）.The femoral BMD significantly decreased with the progression of impaired renal function.The multivariate logistic regression analysis showed that sex （OR =2.668,P =0.015）,eGFR （OR =0.860,P =0.043）,iPTH （OR =1.015,P =0.020）,and 25-（OH）-VitD3 （OR =0.824,P =O.001） were independently related to low BMD,while age,BMI,DM,Ca,P,Ca × P,and AKP were not correlated with low BMD（P ＞0.05）.Conclusion The low eGFR,high serum iPTH,and low serum 25-（OH）-VitD3 are risk factors for low BMD in non-dialysis patients with stages 3-5CKD.