【摘要】目的分析维持性血液透析(maintenance hemodialysis，MHD)患者的骨密度和其他临床指标间的关系，探讨导致MHD 患者骨质疏松的危险因素。方法回顾性分析宝鸡市人民医院102 例MHD 患者的临床资料，用定量超声(quantitative ultrasound system, QUS)检测跟骨骨密度的T 值。根据T 值将患者分为骨量正常组(T 值≥-1.0)、骨量减低组(-2.5＜T 值＜-1.0)及骨质疏松组(T 值≤ -2.5)。比较3 组患者各项临床指标的差异，分析T 值和各临床指标间的相关性。结果102 例MHD 患者中41 例骨质疏松(40.2%)，50 例骨量减低(49.0%)，11 例骨量正常(10.8%)。3 组患者的年龄(F=5.054，P=0.032)、25-羟基维生素D(F=18.131，P=0.009)和亚洲人骨质疏松自我筛查工具(osteoporosis self-assessment tool for Asians,OSTA)指数(F=5.714，P=0.043)差异有统计学意义。Pearson 相关性分析提示T 值与年龄呈负相关(r=-0.412, P=0.033)，与25-羟基维生素D(r=0.596, P=0.021)和OSTA指数(r=0.387，P=0.046)呈正相关。多元逐步回归分析结果显示，25-羟基维生素D是影响骨密度T值的主要因素(t=6.214，P＜0.001)。结论MHD 患者骨质疏松发生率高，25-羟基维生素D 缺乏是导致其骨质疏松的主要危险因素。
【Abstract】Objective To analyze the relationship between bone mineral density and the related clinical parameters, and to explore the risk factors for osteoporosis in maintenance hemodialysis (MHD) patients. Methods A total of 102 MHD patients treated in the Department of Nephrology, Baoji People's Hospital were retrospectively analyzed. Bone mineral density (BMD) of calcaneus was measured by quantitative ultrasound examination and expressed as T score. According to T score, the patients were divided into three groups: normal bone mass group (T score ≥-1.0), reduced bone mass group (-2.5＜ T score ＜-1.0), and osteoporosis
(T score ≤-2.5) group. Clinical parameters were compared among the three groups. The correlation between T score and clinical parameters was analyzed. Results Among the 102 MHD patients, 41 patients (40.2%) were divided into osteoporosis group, 50 patients (49.0%) in reduced bone mass group, and 11 patients (10.8%) in normal bone mass group. There were statistical differences in age (F=5.054, P=0.032), 25-hydroxyvitamin D level (F=18.131, P=0.009) and the index of osteoporosis self-assessment tool for Asians (OSTA) (F=5.714, P=0.043) among the three groups. Pearson correlation analysis showed that T score was negatively correlated with age (r=-0.412, P=0.033) and positively correlated with 25-hydroxyvitamin D level (r=0.596, P= 0.021) and OSTA index (r=0.387, P=0.046). Multivariate stepwise regression analysis showed that 25-hydroxyvitamin D level was the main factor affecting T score of BMD (t=6.214, P＜0.001). Conclusions The incidence of osteoporosis was higher in MHD patients. The main risk factor for osteoporosis was 25-hydroxyvitamin D insufficiency.
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