维持性血液透析患者骨密度与颈动脉粥样硬化的相关性研究

Relationship between bone mineral density and carotid artery atherosclerosis in maintenance hemodialysis patients

目的探讨维持性血液透析(MHD)患者骨密度(BMD)与颈动脉粥样硬化(CAS)的相关性。方法选取2015年6月至2016年1月于本院行MHD患者147例,双能X线吸收法(DXA)检测腰椎及股骨的BMD值确定T值,根据不同T值将患者分为骨量正常组(T≥-1)和骨量下降组(T<-1),彩色超声多普勒检测颈动脉内膜中层厚度(IMT)及动脉粥样硬化斑块情况,根据IMT值将患者分为IMT增厚组(IMT≥1 mm)和IMT正常组(IMT<1 mm)。根据有无颈动脉粥样硬化斑块将患者分为斑块阳性组和斑块阴性组。结果与IMT正常组比较,IMT增厚组患者年龄偏高(P<0.01),第3腰椎(L3)、第1~4腰椎(L1~4)平均值、股骨颈、Wards三角以及大粗隆的BMD值偏低(P<0.05)。透析龄与IMT增厚呈正相关(OR=1.013,P=0.031),Wards三角处BMD与IMT增厚呈负相关(OR=0.012,P=0.038)。与斑块阴性组相比,斑块阳性组患者的年龄、透析龄、胆固醇水平偏高(P<0.05),L1、L3、L4、L1~4平均值及股骨颈的BMD值较低(P<0.05)。高透析龄(OR=1.014,P=0.015)、糖尿病肾病(OR=0.193,P=0.046)和胆固醇水平(OR=1.705 ,P=0.026)与发生CAS斑块风险呈正相关。与骨量正常组比较,骨量下降组患者年龄偏高(P<0.01),颈动脉IMT增厚(P<0.05),体重指数(BMI)、血磷、钙磷乘积、三酰甘油水平降低(P<0.01),高水平BMI可能是BMD的保护性因素(P=0.000),IMT增厚可能是BMD下降的危险因素(P=0.049)。Spearman相关性分析显示MHD患者颈动脉IMT厚度与L3、L1~4平均值、股骨颈、Wards三角、大粗隆等多个部位的BMD呈负相关(P<0.05);多因素回归分析显示MHD患者Wards三角处的BMD可能是颈动脉IMT增厚的独立危险因素(t=-2.437,P=0.016)。结论透析龄和Wards三角处的BMD可能是颈动脉IMT增厚的危险因素。高BMI可能是BMD下降的保护性因素,IMT增厚可能是BMD下降的危险因素。MHD患者颈动脉IMT与BMD之间呈负相关,且Wards三角处的BMD可能是颈动脉IMT增厚的独立危险因素。

Objective To analyze the related risk factors and the relationship of bone mineral density and carotid artery atherosclerosis in maintenance hemodialysis patients.Methods From June 2015 to January 2016,147 cases of MHD patients from Dalian central hospital were selected.All pa-tients had BMD assessmnent by dual energy X-ray absorptiometry method(DXA),carotid intimamedia thickness(IMT)and carotid artery atherosclerotic plaque assessment by ultrasound.According to the BMD values,we divided the patients into normal BMD group(T≥-1)and low BMD group(T<-1).According to the IMT values,we divided the patients into thickening IMT group(IMT≥1 mm)and normal IMT group(IMT<1 mm).Results①The BMD levels of L1-L4,femoral neck,Wards triangle,great tuberosity decreased significantly in thickening IMT group(P<0.05).Dialysis age was positively correlated with thickening IMT,and the BMD of Wards triangle was negatively correlated with thickening IMT.②MHD patients in the positive plaque group had a sigificantly older age and di-alysis age than the ones in the negative plaque group(P<0.05),the BMD of L1,L3,I4,L1-L4 and femoral neck was significantly decreased,the level of total cholesterol was increased significantly(P<0.05).Dialysis age(OR=1.014,P=0.015)and cholesterol(OR=1.705,P=0.026)were positively correlated with the carotid atherosclerotic plaques,and the diabetic nephropathy was positively correla-ted with carotid atherosclerotic plaque(OR=0.193,P=0.046).③MHD patients in the low BMD group had a significantly older age than the ones in the normal BMD group(P<0.01),but the IMT thicker in the low BMD group(P<0.05).The levels of serum phosphorus,calcium-phosphorus prod-uct,triacyIglycerol and body mass index(BMI)in the low BMD group were significantly lower than normal BMD group(P<0.05).In the MHD patients BMI was a protective factor for osteopenia,and IMT was a risk factor for osteopenia.④Spcarman correlation analysis showed that the thickness of the carotid IMT and the BMD of L3,L1-14,femoral neck,Wards triangle,great trochante were negatively correlated in MHD patients(P<0.05).In multiple regression analysis,the BMD of Wards triangle was associated significantly and independently with carotid artery IMT.Conclusions Both of higher dialysis age and lower BMD of Wards triangle are risk factors for the thickness of IMT.BMI is a protective factor for the BMD,and IMT may be a risk factor for osteopenia.Carotid IMT is negatively associated with bone mineral density,and it suggests that the bone mineral density is associated with the develop-ment of AS.