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目的观察维持性血液透析患者发生骨质疏松的危险因素及骨质疏松与血清钙、磷、甲状旁腺素的关系。方法选择绍兴市中医院肾内科2012年1月—2015年12月进行维持性血液透析患者200例进行研究,将其分为骨质疏松组93例,非骨质疏松组107例。收集患者的临床资料,测定患者的跟骨骨密度及血清钙、磷、甲状旁腺素水平。结果骨质疏松组患者男性比例(33.3%)低于非骨质疏松组(62.6%)(P<0.05),骨质疏松组≥60岁患者比例(63.4%)高于非骨质疏松组(29.9%)(P<0.05),骨质疏松组患者体重、身高、体重指数[(59.34±10.27)kg、(1.62±0.08)m、(20.89±1.34)kg/m~2]均低于非骨质疏松组[(67.35±12.63)kg、(1.67±0.06)m、(22.14±2.54)kg/m~2](P<0.05)。骨质疏松组血磷和甲状旁腺素水平(1.91±0.57)mmol/L、(381.34±77.36)ng/L均高于非骨质疏松组(1.64±0.52)mmol/L、(243.64±64.35)ng/L(P<0.05),2组血钙比较差异无统计学意义(P>0.05)。Logistic回归分析显示:性别、年龄、血磷是维持性血液透析患者骨质疏松的独立影响因素(P<0.05)。女性、高龄、血磷升高是维持性血液透析患者骨质疏松的独立危险因素。维持性血液透析患者骨密度值与血清钙、磷、甲状旁腺素水平差异均无统计学意义(均P>0.05)。结论女性、高龄、高磷血症是维持性血液透析患者骨质疏松的独立危险因素,维持性血液透析患者的骨密度与血清钙、磷、甲状旁腺素水平无显著相关性。
Objective To observe the risk factors of osteoporosis and the relationship between osteoporosis and serum calcium, phosphorus and parathyroid hormone in maintenance hemodialysis patients. Methods 200 patients with maintenance hemodialysis in Shaoxing Hospital of Traditional Chinese Medicine from January 2012 to December 2015 were selected and divided into osteoporosis group (n = 93) and non-osteoporosis group (n = 107). The clinical data were collected and the calcaneal bone mineral density and serum calcium, phosphorus and parathyroid hormone levels were measured. Results The percentage of male patients in osteoporosis group (33.3%) was lower than that of non-osteoporosis group (62.6%) (P <0.05) (59.94 ± 10.27) kg, (1.62 ± 0.08) m, (20.89 ± 1.34) kg / m ~ 2] in osteoporosis group were significantly lower than those in non-osteoporosis group (29.9%, P <0.05) Osteoporosis group (67.35 ± 12.63) kg, (1.67 ± 0.06) m, (22.14 ± 2.54) kg / m 2] (P <0.05). The levels of serum phosphorus and parathyroid hormone in osteoporosis group (1.91 ± 0.57) mmol / L and (381.34 ± 77.36) ng / L were significantly higher than those in non-osteoporosis group (1.64 ± 0.52 mmol / L and 243.64 ± 64.35 ) ng / L (P <0.05). There was no significant difference in serum calcium between the two groups (P> 0.05). Logistic regression analysis showed that sex, age and serum phosphorus were the independent influencing factors of osteoporosis in maintenance hemodialysis patients (P <0.05). Women, elderly, elevated serum phosphate is an independent risk factor for osteoporosis in maintenance hemodialysis patients. There was no significant difference in BMD and serum levels of calcium, phosphorus and parathyroid hormone among patients with maintenance hemodialysis (all P> 0.05). Conclusion Female, elderly and hyperphosphatemia are independent risk factors for osteoporosis in maintenance hemodialysis patients. There is no significant correlation between BMD and serum calcium, phosphorus and parathyroid hormone levels in maintenance hemodialysis patients.