不同运动方式对维持性血液透析患者骨密度的影响

目的探讨维持性血液透析患者骨质疏松危险因素及不同运动方式干预后骨密度的变化。方法选取血液透析中心236例维持性血液透析患者并收集相关临床资料,将患者按照是否合并骨质疏松分为两组,对骨质疏松发生的危险因素进行单因素分析,对经单因素分析有显著差异的危险因素作二元Logistic回归分析;然后从中选取108例研究对象按年龄、性别随机分为4组:对照组(A组)、有氧运动联合抗阻运动组(B组)、有氧运动组(C组)及抗阻运动组(D组),每组各27例,研究观察24周,分别在干预前及24周末比较4组的骨密度。结果骨质疏松组女性比例、年龄、透析月龄、血磷、甲状旁腺素水平均高于非骨质疏松组(P0.05),血红蛋白低于非骨质疏松组(P0.05),性别、年龄、PTH是维持性血液透析患者骨质疏松的危险因素(P0.05)。A组、B组、C组、D组在运动干预前骨密度两两比较差异无统计学意义(P0.05);运动干预24周后,与A组相比较,B组、C组、D组骨密度差异均有统计学意义(P0.05); B组、D组骨密度在运动24周末较运动前比较差异有统计学意义(P0.05)。结论性别、年龄、PTH是维持性血液透析患者骨质疏松的危险因素。有氧联合抗阻运动改善骨密度方面效果更理想,而抗阻运动优于有氧运动;坚持长久持续的康复运动更能有效地改善血液透析患者的骨质疏松问题。

Effect of different exercise modes on bone mineral density in maintenance hemodialysis patients

Objective To explore the risk factors of osteoporosis in maintenance hemodialysis patients, and to observe the changes of bone mineral density (BMD) after intervention with different exercise methods. Methods The relevant clinical data of 236 maintenance hemodialysis patients in the hemodialysis center of our hospital were collected. The patients were divided into two groups according to whether or not combined with osteoporosis. The risk factors of osteoporosis were analyzed with single factor analysis. Binary logistic regression analysis were performed on risk factors which were significantly different in single factor analysis. One hundred and eight research subjects were selected and randomly divided into four groups according to age and gender, control group (group A), aerobic exercise combined resistance exercise group (group B), aerobic exercise group (group C), and resistance exercise group (group D), with 27 cases in each group. The study lasted for 24 weeks. BMD was compared among the four groups before and after 24-week intervention. Results The proportion of women, age, month of dialysis, blood phosphorus, and parathyroid hormone in the osteoporosis group were higher, and hemoglobin was lower than those in the non-osteoporosis group (P<0.05). Gender, age, and PTH were risk factors for osteoporosis in patients with maintenance hemodialysis (P<0.05). There was no significant difference in BMD among group A, group B, group C, and group D before exercise intervention (P>0.05). After 24 weeks of exercise intervention, BMD was statistically significant in groups B, C, and D, compared to that in group A (P<0.05). BMD in group B and group D at the end of 24 weeks of exercise was significantly different compared to that before exercise (P<0.05). Conclusion Gender, age, and PTH are risk factors for osteoporosis in maintenance hemodialysis patients. Aerobic exercise combined with resistance exercise is more effective than pure aerobic exercise or resistance exercise in improving BMD. Resistance exercise is better than aerobic exercise. Long-term continuous rehabilitation exercise effectively relieves osteoporosis in hemodialysis patients.