透析前慢性肾功能衰竭患者骨密度和髋部几何结构参数变化的研究

Bone mineral density and hip structural analysis in patients with predialysis chronic renal failure

目的探讨透析前慢性肾衰患者骨密度和髋关节几何结构参数的变化。方法采用回顾性研究方法,选取2013年5月至2017年11月首都医科大学附属北京友谊医院收治的透析前慢性肾衰患者272例作为病例组。按照1:1的比例匹配健康病例作为对照组。采用双能X线骨密度仪(DXA)测量受试者的腰椎、股骨颈、股骨粗隆间及全髋的骨密度。并使用髋部结构分析(HAS)程序获得髋关节几何测量值。统计学分析髋关节几何参数与年龄、体重指数、估算肾小球滤过率(eGFR)和骨密度的关系。结果在股骨颈狭区、股骨粗隆间区和股骨干区病例组测量的皮质骨内宽度、横截面积、截面模量、皮质骨厚度和屈曲应力参数测量值与对照组的差异均具有统计学意义(P<0.05)。股骨粗隆间区横截面积与总腰椎骨密度(r=0.58)、股骨颈狭区CT与股骨颈骨密度(r=0.92)及股骨粗隆间区CT与总髋部骨密度(r=0.81)的相关性最高。结论髋关节几何结构改变与慢性肾衰高度相关,测量髋部几何结构可提高慢性肾衰患者骨强度评估的精确性。

Objective To assess alterations of hip structural parameters and bone mineral density in patients with predialysis chronic renal failure(CRF).Methods A total of 272 patients with predialysis CRF,who were treated in our hospital during May 2013 to Nov 2017 without dialysis,were selected as the case group and 272 healthy people as the control group in this retrospective study.The bone mineral density(BMD)of all subjects were measuered by dual-energy X-ray absorptiometry(DXA) in the lumbar spine,femoral neck,intertrochanteric femur and total hip.Hip structural analysis(HSA) program was used to obtain hip joint geometric measurements.The associations between hip geometric parameters and age,estimated glomerular filtration rate,and bone mineral density were analyzed.Results The ECW,CSA,Z,CT,and BR presented significant difference between patient group and control group at all regions(NN,IT,FS)(P <0.05).The highest correlations were observed for CSA IT with total lumbar BMD(r=0.58),CT NN with femoral neck BMD(r=0.92),and CT IT with total hip BMD(r=0.81).Conclusion Hip joint geometry changes are highly correlated with chronic renal failure.Hip structural analysis may improve the accuracy of bone strength assessment in patients with chronic renal failure.