不同类型肝素对维持性血液透析患者骨密度的影响

Impact of different types of heparin on osteoporosis in maintenance hemodialysis patients

目的研究不同类型低分子肝素对维持性血液透析(maintenance hemodialysis,MHD)患者骨密度(born mineral density,BMD)的影响。方法选择2014年10月至2015年5月在华中科技大学附属同济医院血液透析中心接受治疗且无明显出血倾向的MHD患者88例,根据透析过程中的肝素使用情况,将88例MHD患者分为低分子肝素钠组、低分子肝素钙组和普通肝素组。低分子肝素钠组中有13例使用低分子肝素钠注射液,31例使用依诺肝素钠注射液,19例使用低分子量肝素钠注射液。收集受试者的临床资料包括性别、年龄、透析时间、透析方式、内瘘位置、原发疾病、不同类型肝素使用时间、抗高血压药物使用情况、血压、血红蛋白、C反应蛋白、血钾、血磷、血钙、碱性磷酸酶、全段甲状旁腺素、透析前尿素氮、血肌酐、尿酸和血总胆固醇。用骨密度仪检测所有患者BMD,所有结果以T-Score表示。BMD采用WHO推荐的T-Score评分法:T≥-1为骨质正常;-2.5<T<-1为骨量减少;T≤-2.5为骨质疏松。结果与普通肝素组比较,低分子肝素钙组血钙磷乘积明显升高(P<0.05);与低分子肝素钙组比较,低分子肝素钠组碱性磷酸酶明显升高(P<0.05),BMD减低的发病率明显增加(P<0.05)。低分子肝素钠组内,依诺肝素钠注射液组的平均BMD水平明显低于低分子量肝素钠注射液组(P<0.05),但是低分子量肝素钠注射液组、依诺肝素钠注射液组和低分子肝素钠注射液组的骨质疏松率无明显差异。结论使用低分子肝素钙对MHD患者的BMD影响较小,骨质疏松发生率会相对较少,对患者的生存质量较好。

Objective To evaluate the relationship between different types of heparin and osteoporosis in maintenance hemodialysis （MHD） patients.Methods Eighty-eight patients subject to MHD without obvious bleeding tendency in the Hematodialysis Center of Tongji Hospital of Huazhong University of Science ＆ Technology from Oct.2014 to May 2015 were selected and divided into the low-molecular-weight heparin （LMWH） sodium group, the LMWH calcium group and the unfrationated heparin （UFH） group according to the uses of heparin during the dialysis processes.Thirteen patients in the low-molecular-weight heparin sodium group were given fluxum, 31 given clexane, and 19 given LMWH.The clinical data including age, gender, time and method of MHD, fistula position, primary disease, the drug use, blood pressure, hemoglobin, C-reactive protein, serum potassium, serum calcium and phosphorus, alkaline phosphatase, parathyroid hormone, urea nitrogen, creatinine, uric acid and blood total cholesterol were analyzed.In addition, the bone mineral density （BMD） was detected by Bone Mineral Densitometer.Results The Ca＊P in LMWH group increased significantly compared to the UFH group.BMD and ALP in LMWH sodium group showed a higher rate of decrease than in the LMWH calcium group.The mean BMD level in the enoxaparin sodium group was significantly lower than in the Jipailin group.Conclusions Among the MHD patients, the use of LMWH had small effect on the BMD of patients, the occurrence rate of osteoporosis was relatively low, and the quality of life of patients was relatively good.