影响维持性血液透析患者骨密度相关因素分析

Factors associated with bone mineral density in maintenance hemodialysis patients

目的观察维持性血液透析患者骨质疏松现状,研究骨密度及骨代谢指标间关系,讨论影响骨质疏松的危险因素。方法选取维持性血液透析患者125例,收集一般资料及透析相关信息,检测25羟维生素D,骨源性碱性磷酸酶,跟骨骨密度,进行横断面研究。应用SPSS19.0软件,P<0.05为差异有统计学意义。结果维持性血液透析患者骨质疏松发生率为48%,25羟维生素D缺乏为30.4%。不同性别间骨质疏松患病率差异无统计学意义。绝经女性骨密度显著低于未绝经女性(P<0.001)。女性25羟维生素D水平显著低于男性(P=0.026)。肾小管间质性疾病者骨密度明显低于慢性肾小球肾炎者(P=0.001)。不运动者骨密度明显低于运动者(P<0.001)。骨密度与年龄,透析龄显著负相关(r=-0.387,P<0.001,r=-0.190 P=0.034)。老龄、绝经、轻体重、不运动、肾移植是维持性透析患者骨质疏松的危险因素。结论维持性血液透析患者骨质疏松和25羟维生素D缺乏发生率高,但二者间无相关性。老龄、绝经、轻体重、不运动、肾移植后应用激素及免疫抑制剂是终末期肾病维持性透析患者骨质疏松的危险因素。

Objective To observe the prevalence of osteoporosis and to investigate the associations between bone mineral density（ BMD） and serum biochemical markers in maintenance hemodialysis patients,and to explore the risk factors of osteoporosis.Me thods One hundred and twenty-five patients undergoing hemodialysis were selected. The general data and dialysis-related information were collected. The levels of 25- hydroxyvitamin D,bone-specific alkaline phosphatase,and BMD at the calcaneus were measured. Statistical analysis was performed using the SPSS version 19. 0. P〈0. 05 was accepted as statistically significant.Re sults The prevalence of osteoporosis was 48% and 25-hydroxyvitamin D deficiency was 30. 4% in maintenance hemodialysis patients. No statistically difference of the prevalence of osteoporosis was found between the genders. BMD was significantly lower in post-menopausal women than in pre-menopausal women（ P 〈0. 001）. 25-hydroxyvitamin D was significantly lower in female patients than in male patients（ P = 0. 026）. BMD was significantly lower in tubulointerstitial nephritis patients than in chronic glomerulonephritis patients（ P = 0. 001）. BMD was lower in patients with sedentary lifestyle（ P〈 0. 001）. BMD was negatively correlated with age and duration of hemodialysis（ r =- 0. 387,P 〈0. 001,r =- 0. 190,P = 0. 034,respectively）. Older age,post-menopause,lowbody weight,sedentary lifestyle,and renal transplantation were risk factors for osteoporosis in maintenance hemodialysis patients. Conclusion The prevalence of osteoporosis and 25- hydroxyvitamin D deficiency are high in maintenance hemodialysis patients,but no association is found between them. Older age,post-menopause,lowbody weight,sedentary lifestyle,and glucocorticoid and immunosuppressant therapy after renal transplantation are risk factors for osteoporosis in maintenance hemodialysis patients.