腹膜透析患者骨密度测定与分析

Determination of bone mineral density in patients undergoing continuous ambulatory peritoneal dialysis

目的:研究腹膜透析患者骨密度现状,分析其骨密度影响因素,为骨质疏松早期诊断和预防骨折发生提供临床依据。方法:完整收集我院肾内科慢性肾衰竭腹膜透析患者资料共85例,超声骨密度仪测定跟骨骨密度,同时采集患者临床、生化指标。结果:77.6%患者骨量异常,22.4%患者骨量正常。骨量异常患者的甲状旁腺素、肌酐和碱性磷酸酶水平高于骨量正常患者,但骨量异常患者的甘油三酯水平低于骨量正常患者。Logistic回归分析显示,肌酐的对数(OR=8.88,P=0.029)、钙磷乘积(OR=7.81,P=0.039)是腹膜透析患者骨量异常的危险因素。结论:腹膜透析患者骨量异常患病率高,早期发现骨量异常并给予综合性治疗,减少患者致残率及病死率,改善腹膜透析患者生存质量及生存率。

Objective： To investigate the status of bone mineral density（ BMD）,and analyze the risk factors associated with BMD in patients undergoing continuous ambulatory peritoneal dialysis（ CAPD） for clinical evidences in early diagnosis of osteoporosis and prevention of osteoporotic fractures in such patients.Methods： Full clinical data,including BMD measured with ultrasonic measuring device as well as clinical indicators and biochemical markers,were obtained and retrospectively analyzed in 85 CAPD cases.Results： Bone mass density was abnormal in 77.6%,and normal in 22.4% of the 85 patients.Patients with abnormal bone mass density had higher levels of parathyroid hormone,creatinine and alkaline phosphatase,yet lower level of triglycerides.Logistic regression analysis indicated that the risk factors were associated with logarithm of creatinine（ OR = 8.88,P = 0.029） and calcium-phosphorus product（ OR = 7.81,P = 0.039）.Conclusion： CAPD patients have higher incidence of abnormal bone mass density.Earlier measurement of the bone mass and comprehensive therapy of the abnormality may improve the quality of life and survival rate as well as reduce the disability and mortality for such patients.