【摘要】 目的观察维持性血液透析合并严重继发性甲状旁腺功能亢进患者的骨密度。方法回顾性分析55例维持性血液透析合并严重继发性甲状旁腺功能亢进(血清全段甲状旁腺素大于正常值高限的9倍)的患者的临床资料,以双能X线吸收法来测定腰椎和股骨颈的骨密度,观察其分布及相关因素。结果经过双能X线吸收法测定,腰椎T值的均值为-1.73±1.29,其中骨质疏松占23.64%(T值≤-2.5),骨量减少占50.91%(-2.5<T值<-1.0),骨量正常为25.45%(T值≥-1.0)。进行两变量直线相关分析,T值与全段甲状旁腺素(r=-0.506,P=0.000)、碱性磷酸酶(r=-0.336,P=0.012)、白蛋白(r=0.268,P=0.048)之间存在直线相关关系。第一到第四腰椎T值的均值分别为-1.28±1.25、-1.54±1.25、-1.79±1.45、-2.11±1.42,组间比较F=3.787、P=0.011,差异有统计学意义;趋势检验F=11.328、P=0.001,提示随着腰椎位置更低,T值降低且其降低趋势存在统计学意义,即骨密度下降更明显。左侧股骨颈T值的均值为-1.72±1.21,其中骨质疏松占25.45%(T值≤-2.5),骨量减少占49.09%(-2.5<T值<-1.0),骨量正常为25.45%(T值≥-1.0),进行两变量直线相关分析,T值与全段甲状旁腺素(r=-0.346,P=0.010)、碱性磷酸酶(r=-0.402,P=0.002)、白蛋白(r=0.441,P=0.001)之间存在直线相关关系。对上述结果行配对卡方检验(χ~2=0.111,P=0.990),提示双能X线吸收法对腰椎和股骨颈两个部位骨密度的诊断结果相同;Kappa检验(Kappa=0.331,P=0.001),提示双能X线吸收法对两个部位骨密度的诊断具有一致性。结论维持性血液透析合并严重继发性甲状旁腺功能亢进患者普遍存在骨质疏松和骨量减少,双能X线吸收法对腰椎和股骨颈两个部位骨密度的诊断具有一致性,骨密度与全段甲状旁腺素、碱性磷酸酶、白蛋白相关。更多还原

【Abstract】 Objective To study the bone mineral density( BMD) of maintenance hemodialysis(MHD) patients with serious secondary hyperparathyroidism. Methods The enrolled consisted of 55 MHD subjects in our hospital,including 33 males and 22 females. The gender,age,height,weight,dialysis duration,and biochemical indicators were investigated,and the BMD was tested by dual energy X-ray absorptiometry( DXA). Results Based on the tests of DXA,the T score of lumbar spine was-1. 73 ± 1. 29,osteoporosis and osteopenia accounted for 23. 64% and 50. 91%,respectively. The associated factors of BMD included iP TH( r =-0. 506,P = 0. 000),ALP( r =-0. 336,P = 0. 012),and serum albumin( r =0. 268,P = 0. 048). Trend test showed BMD was gradually reduced from L1 to L4( F for trend = 11. 328,and P for trend = 0. 001). The T score of left femoral neck was-1. 72 ± 1. 21,and osteoporosis and osteopenia accounted for 25. 45% and 49. 09% respectively,respectively. The associated factors of BMD included iP TH( r =-0. 346,P = 0. 010),ALP( r =-0. 402,P = 0. 002),and serum albumin( r = 0. 441,P = 0. 001). Paired chi-square test revealed similar diagnosis of BMD between lumbar spine and femoral neck. Conclusions In our study,the prevalence of osteoporosis and osteopenia was high. The diagnosis results of BMD are similar between lumbar spine and femoral neck. The associated factors of BMD include iP TH,ALP and serum albumin.更多还原