血液透析患者跟骨骨量减少与大动脉僵硬的关系

目的本研究旨在探讨血液透析患者低骨量与大动脉僵硬的关系。方法选择首都医科大学附属朝阳医院血液净化中心维持性血液透析患者41例。应用跟骨超声骨密度测定仪进行跟骨密度测定,同时测量颈总动脉僵硬度:采用日本Aloka Prosound α 10型彩色多普勒超声诊断仪,高分辨血管探头(频率7.5～13MHz),Echo-tracking技术(血管壁回声跟踪技术)测量颈总动脉僵硬度,以颈总动脉硬化参数β表示。β=In(Ps/Pd)]/(Ds-Dd)/Dd](Ds:血管收缩期内径,Dd:血管舒张期内径,Ps:收缩压,Pd:舒张压)。同时测定血清25-羟维生素D3、钙、磷、全段甲状旁腺素(intact parathyroid hormone,iPTH),C-反应蛋白、白蛋白、血脂水平。结果患者平均(57.0±12.3)岁。跟骨密度为(-2.1±0.8),14.6%的患者存在骨质疏松,58.5%的患者存在骨量减少;Pearson相关分析显示颈总动脉硬化参数β与跟骨密度呈负相关(r=-0.453,P=0.002);与血25-羟维生素D3呈负相关(r=-0.337,P=0.031);与血磷呈正相关(r=0.391,P=0.022);与平均动脉压呈正相关(r=0.298,P=0.043);与年龄呈正相关(r=0.477,P=0.002);而与校正后血钙、iPTH、C-反应蛋白、白蛋白、血脂水平无相关性。多元逐步回归分析显示,年龄(β=0.311,P=0.008)、跟骨密度(β=-0.218,P=0.043)是颈总动脉硬化参数β的独立影响因素。跟骨密度与25-羟维生素D3呈正相关(r=0.315,P=0.049);与年龄呈负相关(r=-0.381,P=0.014);与血磷呈负相关(r=-0.323,P=0.046),而与校正后血钙、iPTH无相关性。结论血液透析患者普遍存在低骨量,而低骨量与大动脉僵硬度增加独立相关。

Association of calcaneal osteopenia with arterial stiffness in hemodialysis patients

Objective To determine the relationship between estimated calcaneal bone mineral density （BMD） and arterial stiffness in hemodialysis patients. Methods Forty one patients on maintenance hemodialysis were recruited. Estimated calcaneal BMD was measured by a calcaneal quantitative ultrasound instrument. Stiffness index β of the right common carotid artery （CCA） was measured using an ultrasonic phase-locked echotracking system （Prosound α10; Aloka, Japan） equipped with a high-resolution real-time 7.5-13 MHz linear scanner. Stiffness index β = ln （Ps/Pd）]/（Ds-Dd）/Dd], where Ps and Pd are the brachial systolic and diastolic blood pressures, respectively, and Ds and Dd are the systolic and diastolic inner diameters of CCA, respectively. Serum 25-hydroxyvitamin D3 and intact parathyroid hormone （iPTH） were detected by electrochemiluminescence. Serum calcium, phosphorus, Creactive protein, albumin, total cholesterol, high density lipoprotein, low density lipopro- tein and triglyceride were determined with standard methods. Results The mean age of the patients was 57.0 ±12.3 years. The mean estimated calcaneal BMD was -2.1±0.8, meaning that 14.6% of the patients had osteoporosis, and 58.5% had osteopenia. Pearson correlation analysis indicated that stiffness index β was negatively correlated with calcaneal BMD （r=-0.453, P=0.002） and 25-hydroxyvitamin D3 （r=-0.337, P=0.031）, and was positively correlated with serum phosphorus （r=0.391, P=0.022）, mean arterial pressure （r=0.298,P=0.043） and age （r= 0.477, P=0.002）, but had no correlation with serum calcium, iPTH, C-reactive protein, albumin, and lipids. Mul- tiple stepwise regression analysis showed that age （β=0.311, P=0.008） and calcaneal BMD （β=-0.218,P=0.043） were the independent variables responsible for stiffness index β. Estimated calcaneal BMD was positively correlated with 25-hydroxyvitamin D3 （r=0.315, P=0.049） and negatively correlated with age （r=-0.381, P=0.014） and serum phosphorus （r=-0.323, P=0.046）, but had no correlation with serum calcium and iPTH. Conclusion Calcaneal osteopenia is prevalent in hemodialysis patients, and it is independently correlated with carotid arterial stiffness.