维持性血液透析患者血浆同型半胱氨酸与骨密度的相关性研究

目的 探讨维持性血液透析（MHD）患者血浆同型半胱氨酸（Hcy）与指骨骨密度（BMD）的关系.方法 选择2006年2月至2010年2月在我院住院的MHD患者94例,分别将男性和女性患者分为3组,骨质疏松组：T值＜-2;骨量减少组：T值-2～-1;正常骨量组：T值＞-1.分别比较3组男性和3组女性患者年龄、血钙、血磷、碱性磷酸酶（ALP）、血浆Hcy.对血浆Hcy水平与指骨BMD进行相关性分析,用逐步回归法以指骨BMD为自变量建立多元线性回归方程以分析指骨BMD的影响因素.结果 骨质疏松组年龄均大于骨量减少组和正常骨量组（P＜0.05）,骨量减少组年龄大于正常骨量组（P＜0.05）.3组血钙、血磷、ALP、Hcy差异无统计学意义（P＞0.05）.男性血浆Hcy水平与指骨BMD无相关性（r=0.267,P＞0.05）.年龄是指骨BMD的影响因素（回归系数b1=-0.002,P=0.022）.骨质疏松组血浆Hcy水平均高于骨量减少组和正常骨量组（P＜0.05）,而骨量减少组和正常骨量组Hcy差异无统计学意义（P＞0.05）.3组血钙、血磷、ALP差异无统计学意义（P＞0.05）.女性血浆Hcy水平与指骨BMD呈负相关（r=-0.527,P＜0.05）.年龄和Hcy是指骨BMD的影响因素（回归系数b1=-0.002,P=0.011;回归系数b4=-0.003,P=0.048）.结论 女性MHD患者高血浆Hcy水平可能与指骨BMD降低有关,男性MHD患者血浆Hcy水平与指骨BMD无相关性.血浆Hcy升高可能是女性MHD患者骨质疏松潜在的危险因素.

Relationship between plasma homocysteine and bone mineral density in patients with maintenance hemodialysis

Objective To investigate the relationship between plasma homocysteine （Hcy） and phalangeal bone mineral density （BMD） in patients with maintenance hemodialysis （MHD）. Methods Ninety-four MHD patients in our hospital during Feb. 2006 to Feb. 2010 were selected, and male patients and female patients were divided into three groups respectively： osteoporotic group, T score 〈2; low bone mass group, T score - 2- - 1; normal bone mass group, T score〉 - 1. Age, serum calcium, serum phosphate, serum alkaline phosphatase （ALP） and plasma Hcy were compared among three male group and three female groups respectively. Correlation analysis was used to evaluate the relationship between plasma Hcy and phalangeal BMD. By using phalangeal BMD as the independent variable, the multiple linear regression equation was established to analyze the influencing factors of phalangeal BMD. Results Age in osteoporotic group was older than that in low bone mass group and normal bone mass group （P〈0. 05）, and age in low bone mass group was older than that in normal bone mass group （P〈0. 05）. There was no statistically significant difference in serum calcium, serum phosphate, serum ALP and plasma Hcy among the groups （P〉0. 05）. Plasma Hcy was not related to phalangeal BMD among male MHD patients （r= 0. 267, P〉0. 05）. Age was the risk factor for phalangeal BMD （regression coefficients b1 = -0. 002, P = 0. 022）. As compared with low bone mass group and normal bone mass group, plasma Hcy level was higher in osteoporotic group （P〈0. 05）,but there was no significant difference in plasma Hcy between low bone mass group and normal bone mass group （P〉0. 05）. There was no statistically significant difference in serum calcium, serum phosphate, serum ALP and plasma Hcy among the groups （P〉0. 05）. Phalangeal BMD was negatively correlated with plasma Hcy in female MHD patients （r = -0. 527, P〈0. 05）. Age and Hcy were the risk factors for phalangeal BMD in female MHD patients （regression coefficients b1 = - 0. 002, P = 0.011 ; b4 = - 0. 003, P = 0.04B）. Conclusions Elevated Hcy level in female MHD patients may be correlated with the decrease of phalangeal BMD, while Hcy level in male MHD patients has no correlation with phalangeal BMD. Hcy may be a potential risk factor for osteoporosis in female MHD patients.