终末期肾脏病透析患者骨密度与冠脉钙化的相关性分析

目的探讨终末期肾脏病(end stage renal disease,ESRD)透析患者骨密度与冠状动脉钙化(coronary artery colcification,CAC)之间的相关性。方法本研究为横断面研究。纳入115例ESRD患者,收集相关人口学特征、原发病、实验室检查等资料,双能X射线评估腰椎、股骨颈及髋部骨密度,多层螺旋计算机断层扫描(MSCT)检查患者CAC发生情况。以钙化积分100为界,将患者分为高钙化组和低钙化组。结果高钙化组56例,占维持性透析患者48%,其中男性36例,占高钙化组人数64.3%。高钙化组年龄、透析龄及血清甲状旁腺激素、碱性磷酸酶、25(OH) D水平均明显高于低钙化组,而股骨颈骨密度、髋部骨密度、血清胆固醇水平明显低于低钙化组(P0.05);男性高钙化组股骨颈骨密度及髋部骨密度明显低于低钙化组,且其冠脉钙化积分与股骨颈骨密度(r=-0.34,P0.05)、髋部骨密度(r=-0.65,P0.01)呈负相关。多元线性回归分析校正了年龄、透析龄等因素后仍显示男性髋部骨密度与冠脉钙化积分呈负相关(β=-1870.47,P0.05)。但在女性患者中,高钙化组与低钙化组骨密度无明显差异。结论骨密度降低可能是男性维持性透析患者冠脉钙化风险增高的危险因素。

Association between bone mineral density and coronary calcification in end-stage renal disease patients treated with dialysis

Objective To evaluate the associated between bone mineral density (BMD) and coronary artery calcification (CAC) in end-stage renal disease (ESRD) patients treated with dialysis. Methods This study was a cross-sectional study. One hundred and fifteen patients with ESRD were recruited. Clinical data and blood biochemical indicators of the patients were collected. BMD of the lumbar vertebrae, femoral neck, and hip was measured with dual-energy X-ray absorptiometry (DXA). CAC was measured with multi-slice computed tomography (MSCT) scanning. The patients were divided into high CAC group and low CAC group with a cut-off point of CAC at 100 AU. Results Fifty-six patients (48.6%) had high coronary artery calcification in ESRD patients. Among those, 36 were males (64.3%). Age, dialysis therapy duration, alkaline phosphatase (ALP), intact parathyroid hormone (iPTH), and 25(OH)D level in high CAC group were higher than those in low CAC group. Cholesterol level and BMD of the femoral neck and hip were lower in high CAC group than those in low CAC group (P<0.05). BMD of the femoral neck and hip was lower in males of high CAC group than in low CAC group, and CAC score was negatively correlated with BMD of the femoral neck (r=-0.34, P<0.05) and BMD of the hip (r=-0.65, P<0.01). BMD was not significantly different in females between high CAC group and low CAC group. Conclusion Lower BMD is associated with higher risk of CAC in dialysis males.