维持性血液透析及腹膜透析患者骨密度的评估

目的了解我院MHD及PD患者BMD状况,探讨BMD与临床资料、骨代谢指标及生化指标的相关性及危险因素分析。方法选择我院住院及门诊随访的MHD及PD患者,透析龄均超过3个月,收集患者临床资料及血尿标本。采用超声骨密度仪检测患者BMD状况,对骨量异常患者的BMD及患者一般临床及实验室资料进行相关性分析,并进一步分析透析患者骨量异常的危险因素。采用SPSS19.0软件包进行数据统计及分析。结果 MHD组及PD组骨量异常发生率分别为57.98%,48.54%,有显著统计学差异;随着透析龄的延长,透析患者BMD下降,透析龄3年以上的PD患者比MHD患者的TScore值相对较高,两组间也存在统计学差异。高龄、高透析龄、高BMI、高血磷及高ALP血症是透析患者发生骨量异常的危险因素。结论 MHD患者比PD患者更易发生骨量异常,且随着透析龄的延长,透析患者骨量异常发生率增高,高龄、高透析龄、高BMI、高血磷及高ALP血症是透析患者发生骨量异常的危险因素。

Assessment of bone mineral density in patients with maintenance hemodialysis and peritoneal dialysis

Objective To investigate bone mineral density (BMD) in patients with maintenance hemodialysis (MHD) and peritoneal dialysis(PD) in our hospital, and to understand the risk factors of abnormal bone quantity in patients undergoing MHD and PD. Methods Inpatients and outpatients satisfying the inclusion criteria of dialysis for > 3 months were included (237 MHD and 206 PD cases). Clinical and laboratory parameters were collected, and calcaneal quantitative ultrasounds (QUS) were used to assess bone mineral density in MHD and PD patients. Correlation analyses were performed to assess relationships between clinical and laboratory data. Risk factors analyses for bone abnormalities in dialysis patients were also performed. The SPSS 19.0 software package was used for these statistical analyses. Results The incidence of abnormal bone quantity was significantly greater in MHD (57.98%) versus PD (48.54%) patients (P=0.005). The overall incidence of abnormal bone quantity increased with increasing dialysis durations. Dialysis duration, serum ALP, phosphorus and bone mineral density in dialysis patients had close correlation, P<0.05. Risk factors for abnormal bone quantity include older age, prolonged dialysis duration, increased BMI, ALP and phosphorus levels. Conclusion The incidence of abnormal bone quantity in MHD patients was greater than that of PD patients, and, MHD patients were more prone to have reduced bone mineral density. Bone density of dialysis patients decreases with prolonged dialysis duration. Older age, prolonged dialysis duration, phosphorus and ALP are all risk factors for abnormal bone quantity in dialysis patients.