中老年慢性肾病患者并发骨质疏松的相关因素分析

目的:分析慢性肾病并发骨质疏松的相关因素,为防治慢性肾病并发骨质疏松提供理论依据。方法:研究2016年7月至2017年7月我院收治的70例非透析慢性肾病患者的临床资料。采用双能X线骨密度仪测定患者骨密度值(BMD),并测定相关生化指标及骨代谢指标。根据慢性肾病患者的BMD,将其分为骨质疏松组(30例)和非骨质疏松组(40例)。比较两组患者的性别、年龄、病程、体重指数(BMI)、血钙、血磷、血清的骨碱性磷酸酶(BALP)、甲状旁腺激素(PTH)、维生素D、血肌酐、血清尿酸、肾小球滤过率(GFR)的差异并进行相关性分析。结果:根据WHO诊断标准,本研究中骨质疏松患者达42.86%,女性发病率为50.00%,而男性为32.14%。两组性别构成比无统计学差异(P>0.05)。两组比较,骨质疏松组年龄明显大于非骨质疏松组,病程显著长于非骨质疏松组,BMI低于非骨质疏松组,均具有统计学意义(P <0.05)。两组实验室指标比较,血钙、血磷、血肌酐、血清尿酸及GFR无显著差异(P>0.05);骨质疏松组BALP、PTH高于非骨质疏松组(P<0.05),而维生素D低于非骨质疏松组(P<0.05)。相关性分析显示, BMD与BMI、维生素D呈正相关(r=0.607,0.450,P<0.05);BMD与年龄、病程、BALP及PTH呈负相关(r=-0.581,-0.256,-0.383,-0.551,P<0.05);而BMD与与性别、血钙、血磷、血肌酐、血清尿酸及GFR无明显相关性(P>0.05)。结论:中老年慢性肾病患者具有较高的骨质疏松风险,女性骨质疏松发病率明显高于男性。年龄、病程、维生素D、BMI、 BALP及PTH是慢性肾病患者并发骨质疏松的相关因素,慢性肾病并发症与骨质疏松密切相关,临床中应引起重视。

Analysis of Related Factors of Osteoporosis in Middle-aged and Elderly Patients with Chronic Nephropathy

Objective: To analyze the related factors of chronic nephropathy complicated with osteoporosis, and to provide theoretical basis for prevention and treatment of chronic nephropathy complicated with osteoporosis. Methods: The clinical data of 70 patients with non-dialysis chronic nephropathy from July 2016 to July 2017 were studied. Bone mineral density(BMD) was measured by dual energy X ray absorptiometry and related biochemical indexes and bone metabolism indexes were measured. According to the BMD of patients with chronic nephropathy, they were divided into osteoporosis group(30 cases) and non-osteoporosis group(40 cases). Sex, age, course of disease, body mass index(BMI),) serum calcium, serum phosphorus, serum bone alkaline phosphatase(BALP), parathyroid hormone(PTH), vitamin D, serum creatinine, serum uric acid and glomerular filtration rate(GFR) were compared between the two groups. The difference and correlation analysis of its indexes. Results:According to the diagnostic criteria of WHO, osteoporosis patients in this study reached 42.86%. The incidence rate was 50.00% for women and 32.14% for men. There was no significant difference in sex composition ratio between the two groups(P > 0.05). Compared with non-osteoporosis group, the age of osteoporosis group was significantly larger than that of non-osteoporosis group(P <0.05), and the course of disease was significantly longer than that of non osteoporosis group(P <0.05), BMI was significantly lower than that of non osteoporosis group(P <0.05). There was no significant difference in serum calcium, phosphorus, serum creatinine, serum uric acid and GFR between the two groups(P >0.05). The BALP, PTH of osteoporosis group was higher than that of non-osteoporosis group(P <0.05), but vitamin D was lower than that of non osteoporosis group(P <0.05). The correlation analysis showed that there was a positive correlation between BMD and BMI, vitamin D(r= 0.607, 0.450, P <0.05). BMD was negatively correlated with age, course of disease, BALP and PTH(r=-0.581, 0.256, 0.383, 0.551, P<0.05). There was no significant correlation between BMD and sex, serum calcium, serum phosphorus, serum creatinine, serum uric acid and GFR(P >0.05). Conclusion: The risk of osteoporosis was higher in middle-aged patients with chronic nephropathy, and the incidence of osteoporosis in women was significantly higher than that in men. Age, course of disease, vitamin D, BMI,BALP and PTH are related factors of osteoporosis in patients with chronic kidney disease. The complications of chronic nephropathy are closely related to osteoporosis.