尿毒症血液透析患者骨密度动态变化的影响因素分析

目的:观察维持性血液透析(maintenance hemodialysis,MHD)患者自身骨密度(BMD)动态变化的情况,分析骨密度变化的影响因素。方法:对70例MHD患者观察18个月,观察前后使用双能X射线(DEXA)测定患者髋部BMD,并收集两个时间段的血生化指标。观察前后相应指标的变化情况,分析BMD降低的影响因素及其与BMD变化的关系特点。结果:观察前后对比,BMD的T值、钙、磷、甲状旁腺激素(PTH)有显著性变化(P<0.05);BMD变化值(△T)与透析龄呈正相关(Z=0.288,P=0.015);与BMD基础值呈负相关(r=-0.437,P=0.001);与基础血清肌酐呈负相关(r=-0.318,P=0.007)。结论:MHD患者骨量流失、钙磷PTH代谢障碍持续加重;透析龄、BMD的基础值、血清肌酐水平与BMD降低具有相关性;MHD患者透析早期BMD减低更为明显。

The analysis of the influence factors of dynamic changes of bone density in patients with maintenance hemodialysis

Objective:To observe the dynamic changes of bone density (BMD) in the patients with maintenance hemodialysis (MHD) and analyze the factors influencing the change of bone density.Methods:70 patients with MHD were observed for 18 months. The BMD of the hip was measured by dual energy X ray (DEXA) before and after the observation,and the blood biochemical indexes of the two time periods were collected.The changes of the corresponding indexes before and after the observation were analyzed,and the influencing factors of BMD reduction and its relationship with the changes of BMD were analyzed.Results:Observed before and after BMD T,calcium,phosphorus and PTH had significant changes(P<0.05).The changes of BMD value(delta T) associated with dialy-sis age positively (Z=0.288,P=0.015),BMD was negatively correlated with the basic values (r= -0.437,P=0.001) and serum creatinine (r= -0.318,P=0.007).Conclusions:Calcium loss of bone,calcium phosphorus PTH metabolic disorder in patients with MHD continue to increase.Dialysis age,the basic value of BMD,serum creatinine levels are correlated with the decrease of BMD.MHD patients in early dialysis BMD reduction is more obvious.