CKD5D患者骨折风险的相关因素分析

Clinical analysis of risk factors of fracture patients in CKD5D stage

目的探讨CKD5D骨折患者临床特点及风险相关因素。方法 124例CKD5D患者按既往或现在有无骨折的发生,分为骨折组和非骨折组。记录临床资料如年龄、性别、身高、体质量、透析时间、透析方式、体质量指数、高血压、糖尿病病史、服用药物史;实验室检查指标如血红蛋白、红细胞比积、血肌酐、尿素氮血糖、白蛋白、甘油三酯、胆固醇、高密度脂蛋白、低密度脂蛋白、血钠、血钙、血磷、甲状旁腺激素、碱性磷酸酶、25(OH)Vit D;骨密度检查。结果与非骨折组比较,骨折组血液透析比例更高、透析时间更长,血钙、血磷、PTH、AKP更高,骨密度T值、Z值均明显下降。骨折风险的单因素回归分析提示,透析龄长、高钙、高磷、高PTH、高AKP、高25(OH)Vit D与骨折的发生正相关,腹膜透析、使用钙剂与骨折的发生负相关。多因素逐步回归分析提示,高PTH、高AKP与骨折的发生正相关,腰椎骨密度和使用钙剂与骨折的发生负相关。结论低骨密度是骨折发生的重要危险因素,钙剂的使用能减少骨折风险,CKD5D患者高PTH、高AKP应积极干预。

ObjectiveTo investigate the risk factors of fracture patients in CKD5D stage. MethodsA total of 124 CKD5D patients according to suffering fracture or not in past or at present were divided into fracture group and non fracture group. Clinical data of age, sex, height, body mass index（BMI）, dialysis duration, dialysis patterns, body mass index（BMI）, hypertension, diabetes mellitus（DM） history, drug taking history were recorded. Laboratory examinations included hemoglobin（Hb）, hematocrit（Hct）, serum creatinine（Scr）, blood urea nitrogen（Bun）, albumin（A）, triglyceride （TG）, cholesterol（TC）, high density lipoprotein （HDL）, low density lipoprotein （LDL）, serum sodium（Na＋）, serum calcium（Ca2＋）, serum phosphorus（P）, parathyroid hormone（PTH）, alkaline phosphatase（AKP）, and 25（OH）VitD. And bone mass density（BMD）were measured. ResultsThe fracture patients had longer dialysis duration, higher of hemodialysis ratio, higher serum Ca2＋, serum P, serum PTH and AKP, lower T and Z values of bone density than those patients without fracture. Univariate regression analysis of fracture risk suggested that dialysis age, high calcium, high phosphorus, high PTH, high AKP, high 25 （OH） VitD and fracture were positively correlated with peritoneal dialysis, and was negatively correlated with the use of calcium and peritoneal dialysis.