行维持性血液透析患者骨折影响因素分析

Influencing factors of fractures in maintenance hemodialysis patients

目的探讨行维持性血液透析患者发生骨折的影响因素。方法182例行维持性血液透析患者随访5年,根据骨折发生情况分为骨折组26例和未骨折组156例,比较2组年龄及血红蛋白、白蛋白水平等。采用多因素logistic回归分析行维持性血液透析患者发生骨折的影响因素。结果182例患者发生骨折26例(14.3%),其中肋骨骨折9例(34.6%),肱骨骨折6例(23.1%),股骨骨折5例(19.3%),脊柱骨折3例(11.5%),趾骨及跖骨骨折3例(11.5%)。骨折组年龄[(68.4±11.3)岁]大于未骨折组[(62.1±12.4)岁](t=2.435,P=0.016),年龄≥65岁及糖尿病肾病比率(73.1%、46.2%)均高于未骨折组(53.2%、24.4%)(χ2=25.751,P<0.001;χ2=5.313,P=0.021),慢性肾小球肾炎比率(15.4%)及血红蛋白[(95.50±16.27)g/L]、血清白蛋白[(35.19±4.18)g/L]水平均低于未骨折组[40.4%、(105.27±14.87)g/L、(37.76±5.74)g/L](P<0.05)。年龄(OR=5.864,95%CI:1.463~23.507,P=0.013)、血红蛋白(OR=0.946,95%CI:0.905~0.988,P=0.012)、血磷(OR=4.586,95%CI:1.559~13.491,P=0.006)是行维持性血液透析患者发生骨折的影响因素。结论行维持性血液透析患者骨折多见于肋骨、肱骨、股骨,年龄≥65岁、贫血及血磷水平增高者易发生骨折。

Objective To investigate the influencing factors of fractures in maintenance hemodialysis(MHD)patients.Methods Totally 182MHD patients were followed up for 5years,and were divided into fracture group(n=26)and no-fracture group(n=156).The age,hemoglobin and albumin levels were compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of fractures in MHD patients.Results In 182patients,26 patients had new fractures(14.3%),including rib fractures in 9(34.6%),humerus fractures in 6(23.1%),femoral fractures in 5(19.3%),spinal fractures in 3(11.5%)and phalangeal and metatarsal fractures in 3(11.5%).Fracture group was older than no-fracture group[(68.4±11.3)years vs.(62.1±12.4)years](t=2.435,P=0.016).The percentages of patients aged≥65years and with diabetic nephropathy were higher in fracture group(73.1%,46.2%)than those in no-fracture group(53.2%,24.4%)(χ2=25.751,P<0.001;χ2=5.313,P=0.021),and the percentage of patients with chronic glomerulonephritis and the levels of hemoglobin and albumin were lower in fracture group[15.4%,(95.50±16.27)g/L,(35.19±4.18)g/L]than those in no-fracture group[40.4%,(105.27±14.87)g/L,(37.76±5.74)g/L](P<0.05).Age(OR=5.864,95%CI:1.463-23.507,P=0.013),hemoglobin(OR=0.946,95%CI:0.905-0.988,P=0.012)and serum phosphorus(OR=4.586,95%CI:1.559-13.491,P=0.006)were the influencing factors of fractures in MHD patients.Conclusions Fractures usually occur in the ribs,humerus and femur in MHD patients.Those aged≥65years and with anemia and elevated serum phosphorus are prone to develop fractures.