老年慢性肾脏病患者骨密度水平与颈动脉IMT的相关性研究

目的研究不同分期老年慢性肾脏病(CKD)患者颈动脉粥样硬化与骨密度水平的关系,为CKD不同分期老年人群骨质疏松症与心血管疾病的防治提供相关的理论及临床指导。方法以本院门诊及住院的老年CKD非透析治疗患者为研究对象,健康老人为对照组,采用双能X线吸收法(DXA)测定腰椎骨和股骨区的骨密度水平(BMD),同时采用彩色多普勒超声探查颈动脉内膜-中层厚度(IMT)及粥样斑块的情况;应用SPSS18.0软件包,统计分析骨密度水平与颈动脉粥样硬化的关系。结果 CKD患者骨密度水平均比健康对照组显著降低(-2.4SD±0.18比-0.8SD±0.24,P0.01);在非透析CKD患者中,肾小球滤过率(GFR)与骨密度水平呈现正相关,各组间比较差异有统计学意义(P0.05或P0.01);CKD患者颈动脉内膜中层厚度(IMT)(0.78±0.21比0.71±0.24 mm,P0.01)及斑块形成(66.6%比36%,P0.01)、颈动脉硬化的患病率(66.6%比36%,P0.01)较健康对照组均显著升高;直线相关分析显示,骨密度水平与hs CRP、TG、血磷、i PTH、血红蛋白(Hb)呈正相关(P0.05或P0.01),与GFR、血钙、血白蛋白(SAlb)、IMT、斑块形成、颈动脉硬化的患病率呈负相关(P0.05或P0.01);多因素逐步回归分析显示,年龄、收缩压、糖尿病、吸烟、药物以及BMD是CKD患者颈动脉病变的独立危险因素。CKD患者IMT比对照组显著增厚(P0.01),其颈动脉粥样斑块总检出率66%,对照组的总检出率仅为36%(P0.01),CKD中晚期患者的颈动脉IMT增厚和粥样斑块的阳性率更为明显(P0.05)。结论各期CKD患者骨密度水平均显著降低,且与颈动脉病变相关,骨质疏松可能是CKD患者并发动脉粥样硬化的危险因素之一。动脉粥样硬化斑块的形成,与患者的年龄、血脂、CKD不同分期及骨密度均有显著相关性,骨质疏松的危险因素与之亦有共同点。骨质疏松与动脉粥样硬化高度相关,二者互为因果。

Correlation between bone mineral density and carotid IMT in elderly patients with chronic kidney diseases

Objective To investigate the relationship between bone mineral density (BMD) and carotid atherosclerosis in elderly patients with chronic kidney disease (CKD) at different stages, and to provide theoretical and clinical guidance for the prevention and treatment of osteoporosis and cardiovascular diseases in elderly people with different stages of CKD. Methods The elderly CKD non-dialysis patients in outpatient and inpatient of our hospital were research subjects. The healthy elderly people were in the control group. BMD of the lumbar spine and the femoral region was measured using dual energy X-ray absorptiometry (DXA). The intimal media thickness (IMT) and atherosclerosis plaque of the carotid artery were measured using a color Doppler ultrasonography. SPSS 18.0 software package was used for statistical analysis of the relationship between BMD and carotid atherosclerosis. Results BMD in CKD patients was significantly lower than that in healthy control group (-2.4SD±0.18 vs. -0.8SD±0.24, P<0.01). In non-dialysis CKD patients, glomerular filtration rate (GFR) was positively correlated with BMD, and there were significant differences among groups (P<0.05 or P<0.01). IMT (0.78±0.21 vs. 0.71±0.24 mm, P<0.01) and plaque formation (66.6% vs. 36%, P<0.01) increased in CKD patients. The prevalence of carotid atherosclerosis increased in CKD patients compared to healthy controls (66.6% vs 36%, P<0.01). The linear correlation analysis showed that BMD was positively correlated with hsCRP, TG, serum phosphorus, iPTH, and hemoglobin (P<0.05 or P<0.01), but was negatively correlated with GFR, serum calcium, SAlb, IMT, plaque, and the prevalence of carotid atherosclerosis (P<0.05 or P<0.01). The stepwise regression analysis showed that age, systolic blood pressure, diabetes, smoking, drugs, and BMD were independent risk factors of carotid artery disease in CKD patients. The IMT of CKD patients was significantly thicker than that in the control group (P<0.01). The total detectable rate of carotid atherosclerotic plaques was 66%, which was significantly higher than that of the control group (36%, P<0.01). The positive detectable rate of carotid IMT thickening and atheromatous plaque was more obvious in the middle and late stage of CKD (P<0.05). Conclusion BMD is significantly lower in patients with CKD at various stages and is associated with carotid artery disease. Osteoporosis may be one of the risk factors for atherosclerosis in CKD patients. The formation of atherosclerotic plaque is closely related to age, blood lipid, CKD different stages, and BMD, and has obvious similarities with the risk factors of osteoporosis. There is a close relationship between osteoporosis and atherosclerosis. The two can be either cause or effect and can be affected by a common factor.