单中心终末期肾脏病患者骨量异常的危险因素分析

A single centered analysis on risk factors for abnormal bone mass in patients with end-stage renal disease

目的探讨终末期肾脏病(ESRD)患者骨量异常的危险因素。方法纳入2020年1—12月在沧州市中心医院肾内科住院的228例ESRD患者为研究对象,收集临床资料及化验指标,采用双能X线吸收测定法检测骨密度(BMD)及确定T值。依据T值分为骨量正常组和骨量异常组,骨量异常组包括骨量减少组和骨质疏松组。比较各组年龄、性别、透析龄、是否透析、体重指数(BMI)、血钙(Ca)、血磷(P)、甲状旁腺激素(iPTH)、碱性磷酸酶(ALP)、25羟维生素D_(3)[25-(OH)-VitD3]、C反应蛋白(CRP)的差异,并行logistic回归分析骨量异常的危险因素。结果所有患者骨量异常的发生率高达77.2%;透析患者骨量异常发生率(82.2%)高于非透析患者(73.9%)。各组患者在年龄、性别、BMI、Ca、P、25-(OH)-VitD_(3)、CRP方面比较,差异有统计学意义(均P<0.05);透析患者比例随骨量下降有升高趋势,但差异无统计学意义(P=0.058)。将P<0.1的因素纳入有序多因素logistic回归分析,发现透析(OR=3.305,95%CI为1.399~4.440,P=0.030)、低BMI(OR=0.236,95%CI为-0.153~-0.021,P=0.010)是ESRD患者骨量异常的危险因素。结论透析患者骨量异常发生率高于非透析患者。透析、低BMI是ESRD患者骨量异常的独立危险因素,但预测价值有待进一步评估。

Objective To investigate the risk factors for abnormal bone mass in patients with end-stage renal disease(ESRD).Methods A total of 228 patients with ESRD who were hospitalized in the Department of Nephrology at Cangzhou Central Hospital from January to December 2020 were included in the study,and their clinical data and laboratory indexes were collected.The bone mineral density(BMD)was detected and the T value was determined by dual-energy X-ray absorptiometry.Based on the T value,the patients were divided into the normal bone mass group and the abnormal bone mass group,and the abnormal bone mass group was further divided into the reduced bone mass group and the osteoporosis group.The differences in age,gender,dialysis age,the presence or absence of dialysis,body mass index(BMI),blood calcium(Ca),blood phosphorus(P),intact parathyroid hormone(iPTH),alkaline phosphatase(ALP),25 hydroxyvitamin D_(3)[25-(OH)-VitD_(3)],and C-reactive protein(CRP)were compared among all groups,and logistic regression was performed to analyze the risk factors for abnormal bone mass.Results The incidence of abnormal bone mass was up to 77.2%in all patients,and the incidence of abnormal bone mass in dialysis patients(82.2%)was higher than that in non-dialysis patients(73.9%).There were statistically significant differences in age,gender,BMI,Ca,P,25-(OH)-VitD3,and CRP among all groups(all P<0.05).The proportion of dialysis patients tended to increase with decreasing bone mass,but there was no significant difference(P=0.058).Factors with P<0.1 were included in the multivariate ordered logistic regression analysis,and the results showed that dialysis(OR=3.305,95%CI:1.399 to 4.440,P=0.030)and low BMI(OR=0.236,95%CI:-0.153 to-0.021,P=0.010)were risk factors for abnormal bone mass in patients with ESRD.Conclusion The incidence of abnormal bone mass in dialysis patients is higher than that in non-dialysis patients.Dialysis and low BMI are independent risk factors for abnormal bone mass in patients with ESRD,but the predictive value needs to be further evaluated.