终末期肾病患者骨折影响因素的Meta分析

Risk factors for fracture in patients with end-stage renal disease:a Meta-analysis

目的系统分析终末期肾病患者发生骨折的相关因素。方法计算机检索中国知网、维普、万方、中国生物医学数据库、PubMed以及EMBASE中自建库以来公开发表的相关文献。由2名研究员独立筛选文献、提取资料、纳入文献质量评价,采用Review Manager 5.3软件进行统计分析。结果共纳入19篇文献,合并结果提取8个相关影响因素,其中6个危险因素:年龄(OR=1.28,95%CI:1.20~1.37,P<0.01)、女性(OR=1.93,95%CI:1.51~2.46,P<0.01)、碱性磷酸酶(OR=1.03,95%CI:1.01~1.05,P=0.008)、甲状旁腺激素(OR=1.07,95%CI:1.04~1.10,P<0.01)、糖尿病(OR=1.70,95%CI:1.44~2.02,P<0.01)、透析年限(OR=1.83,95%CI:1.20~2.80,P=0.005);2个保护因素:血清白蛋白(OR=0.81,95%CI:0.69~0.96,P=0.02)和活性维生素D3(OR=0.33,95%CI:0.16~0.67,P=0.002)。结论年龄≥65岁、女性患者、碱性磷酸酶升高、甲状旁腺激素过高或过低、透析年限>6年以及合并糖尿病是终末期肾病患者骨折的危险因素,正常的血清白蛋白和活性维生素D3是降低骨折发生的保护因素。

Objective To systematically explore the factors related to fractures in patients with end-stage renal disease(ESRD).Methods The authors conducted a computerized search of CNKI,VIP,Wanfang,China Biomedical Database,PubMed and Embase for the relevant literature published since their inceptions.Two researchers independently selected and evaluated the quality of the studies,extracted data and utilized Review Manager 5.3 software for statistical analysis.Results A total of 19 articles were retrieved.Among 8 related factors,6 of them were risk factors as follows:age(OR=1.28,95%CI:1.20-1.37,P<0.01),female(OR=1.93,95%CI:1.51-2.46,P<0.01),alkaline phosphatase(OR=1.03,95%CI:1.01-1.05,P=0.008),parathyroid hormone(OR=1.07,95%CI:1.04-1.10,P<0.01),diabetes mellitus(OR=1.70,95%CI:1.44-2.02,P<0.01),duration of dialysis(OR=1.83,95%CI:1.20-2.80,P=0.005)and two protective factors of serum albumin(OR=0.81,95%CI:0.69-0.96,P=0.02)and activated vitamin D3(OR=0.33,95%CI:0.16-0.67,P=0.002).Conclusion Risk factors for fracture in ESRD patients include age≥65 years,female,elevated alkaline phosphatase,abnormal level of parathyroid hormone,dialysis duration>6 years and concurrent diabetes mellitus.Normal levels of serum albumin and activated vitamin D3 are protective factors for fracture.