摘要
目的研究血液净化中心维持性血液透析(MHD)患者合并骨质疏松症(OP)的危险因素及骨折风险预测。方法选择郑州大学第一附属医院2018年5月-2021年5月血液净化中心收治的MHD患者182例,根据其是否合并OP分为合并组(n=74)和非合并组(n=108),收集患者临床资料,并对导致MHD患者发生OP的危险因素进行分析;再通过骨折风险因子评估工具(FRAX)比较两组患者10年主要OP骨折(包括:脊柱、前臂、髋骨、肱骨)和髋部骨折发生概率。结果单因素分析显示,MHD患者合并组与非合并组年龄、性别、体重指数(BMI)、合并糖尿病、慢性肾脏病(CKD)病程、透析时间、女性绝经、身高缩短或驼背、合并骨代谢疾病、低蛋白血症、碱性磷酸酶(ALP)异常增高、血钙异常、血磷异常、iPTH异常、25-羟维生素D[25-(OH)D]不足例数间差异有统计学意义(P<0.05)。多因素分析结果显示,MHD患者发生OP危险因素为年龄≥60岁、性别(女)、BMI<18.50 kg/m^(2)、合并糖尿病、CKD病程≥50月、透析时间≥30月、女性绝经、低蛋白血症、ALP异常增高、iPTH异常、25-(OH)D不足(P<0.05)。合并组主要OP骨折、髋部骨折FRAX骨折风险评估值远高于非合并组,差异有统计学意义(P<0.05);Spearman相关性分析结果显示,主要OP骨折、髋部骨折FRAX骨折风险评估值与MHD患者OP间呈线性正相关(r=0.653、0.472,P<0.05)。结论MHD患者发生OP的独立危险因数相对较多,骨折风险也相对较高,临床需对上述高危人群加以重视,必要时可通过早期干预治疗降低骨折风险。
Objective To study the risk factors of osteoporosis(OP)in patients with maintenance hemodialysis(MHD)in the blood purification center and predict the risk of fracture.Methods 182 MHD patients admitted to the Blood Purification Center of the First Affiliated Hospital of Zhengzhou University from May 2018 to May 2021 were selected and divided into combined group(n=74)and non-combined group(n=108)according to whether they were combined with OP.The clinical data of patients was investigated,and the risk factors that lead to OP in MHD patients were analyzed.The two groups of patients with 10-year major OP fractures(including:spine,forearm,hip,and humerus)were compared through the fracture risk factor assessment tool(FRAX),and the probability of hip fractures was calculated.Results Univariate analysis showed that there were significant differences between combined group and non-combined group of MHD patients in age,gender,body mass index(BMI),diabetes,duration of chronic kidney disease(CKD),dialysis time,female menopause,shortened height or hunchback,combined bone metabolic disease,hypoalbuminemia,and abnormally increased alkaline phosphatase(ALP),abnormal blood calcium,abnormal blood phosphorus,abnormal iPTH,and 25-(OH)D insufficiency(P<0.05).The results of multivariate analysis showed that the risk factors for OP in MHD patients were age≥60,gender(female),BMI<18.50 kg/m^(2),diabetes,duration of CKD≥50 months,dialysis time≥30 months,female menopause,hypoalbuminemia symptoms,abnormally increased ALP,abnormal iPTH and 25-(OH)D deficiency(P<0.05).The risk assessment values of OP fractures and hip fracture FRAX fracture in the combined group were much significantly higher than those in the non-combined group(P<0.05).The results of Spearman correlation analysis showed that there was a linear positive correlation between OP fracture,hip fracture FRAX fracture risk assessment value and OP in MHD patients(r=0.653,0.472,P<0.05).Conclusions There were relatively many independent risk factors for OP in MHD patients,and the risk of fracture was relatively high.Clinical attention should be paid to the above-mentioned highrisk groups.If necessary,early intervention should be used to reduce the risk of fracture.
作者
王琰
罗静
苗金红
WANG Yan;LUO Jing;MIAO Jin-hong(Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052;Quality Control Department,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)
出处
《热带医学杂志》
CAS
2022年第3期373-377,共5页
Journal of Tropical Medicine
基金
河南省高等学校重点科研项目计划(15A310014)
关键词
维持性血液透析
骨质疏松症
血液净化中心
骨折风险预测
Maintenance hemodialysis
Osteoporosis
Blood purification center
Fracture risk prediction
作者简介
王琰(1984-),女,本科,中级职称,研究方向:肾内科及血液净化;通信作者:苗金红,E⁃mail:1635661123@qq.com
