中国骨质疏松杂志

慢性肾脏病患者骨密度与骨代谢生化指标的相关性分析

The correlation analysis between bone mineral density and biochemical markers of bone metabolism in patients with the chronic kidney disease

DOI：10.3969/j.issn.1006-7108.2020.12.007

中文关键词: 慢性肾脏病骨密度骨折骨特异性碱性磷酸酶甲状旁腺素

英文关键词:chronic kidney disease bone mineral density fracture bone-specific alkaline phosphatase parathyroid hormone

基金项目:安徽省公益性研究联动计划项目（1604f0804021）；安徽医科大学校科研基金项目（2017xkj028）

作者	单位
何舒宁郝丽* 张森	安徽医科大学第二附属医院，安徽合肥 230601

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中文摘要:

目的分析慢性肾脏病（chronic kidney disease，CKD）患者骨密度（bone mineral density，BMD）与骨代谢生化指标的相关性，探讨BMD及骨代谢生化指标在慢性肾脏病-矿物质和骨代谢紊乱（chronic kidney disease-mineral and bone disorder，CKD-MBD）早期评估和管理中的价值。方法选取2018年1月1日-2019年9月30日就诊于安徽医科大学第二附属医院肾脏内科的CKD3~5D期患者128例，将CKD组分为CKD3期组、CKD4期组、CKD5期非透析组（CKD5ND组）和CKD5期血液透析组（CKD5HD组）。另选取15例健康人员作为对照组。检测血钙（Ca）、血磷（P）、甲状旁腺素（PTH）、骨特异性碱性磷酸酶（BALP）和血肌酐（SCr）等实验室指标，完善腰椎及左髋关节BMD检查。比较各组间各指标的组间差异，分析腰椎及左髋关节BMD与各指标间的相关性，并利用多元线性回归法分析影响BMD的危险因素。结果 ①BMD状况：CKD3期组、CKD4期组、CKD5ND期组和CKD5HD期组的左髋关节BMD均低于对照组，并随着CKD分期的进展不断降低（P均<0.05）；各组间腰椎BMD差异不具有统计学意义（P>0.05）。②BALP、Ca、P和LogPTH水平：CKD3期组、CKD4期组、CKD5ND期组和CKD5HD期组的BALP水平均高于对照组（P均<0.05）；CKD5ND期组Ca显著低于其他组（P均<0.05），CKD5ND期组和CKD5HD期组P显著高于其他组（P<0.05），CKD5HD期组logPTH水平显著高于其他组（P<0.05）。③相关性分析：Pearson相关分析显示，左髋关节BMD与P、LogPTH、BALP呈负相关（P均<0.05）；腰椎BMD与各项指标之间均无相关性（P均>0.05）。④多元线性回归分析显示，年龄、体质量指数（body mass index,BMI)、SCr和PTH是影响髋关节BMD的危险因素。结论与腰椎BMD相比，髋关节BMD是早期骨代谢异常的敏感指标，并随着CKD进展逐渐降低。髋关节BMD与P、PTH和BALP呈负相关，PTH是影响髋关节BMD的危险因素。早期联合检测髋关节BMD和骨代谢生化指标对早期评估和管理CKD-MBD具有重要的价值。

英文摘要:

Objective To analyze the correlation between bone mineral density (BMD) and bone metabolism biochemical indicators in patients with chronic kidney disease (CKD). To explore the value of BMD and biochemical indexes of bone metabolism in CKD-MBD. Methods From January 1, 2018 to September 30, 2019, 128 patients with stage CKD3 to 5D who were treated in the Department of Nephrology of The Second Hospital of Anhui Medical University were selected. The CKD group was divided into the CKD3 stage group and CKD4 stage group, stage 5 non-dialysis group (CKD5ND stage group) , and stage 5 hemodialysis group (CKD5HD stage group). Another 15 healthy persons were selected as the control group. Detect blood calcium (Ca), blood phosphorus (P), bone specific alkaline phosphatase (BALP), parathyroid hormone (PTH), and serum creatinine (SCr) Laboratory indicators, perfect lumbar spine and left total hip bone mineral density (BMD) examination. Compared each index differences between the groups, and analyzed the correlation between the lumbar and total hip BMD and each index, and analyzed the risk factors affecting BMD by multiple linear regression. Results ①The total hip BMD of the CKD3, CKD4, CKD5ND, and CKD5HD stage groups was lower than that of the control group, and it continued to decrease as the CKD stage progressed (all P<0.05).②BALP, Ca, P and LogPTH levels: The BALP concentrations in the CKD3, CKD4, CKD5ND, and CKD5HD groups were higher than that in the control group. (all P<0.05). Ca in the CKD5ND stage group was lower than other groups (all P<0.05). P in CKD5ND stage group and CKD5HD stage group were higher than other groups (P<0.05). LogPTH in CKD5HD stage group was higher than other groups (P<0.05). ③ Pearson correlation analysis showed that BMD of total hip was negatively correlated with P, LogPTH, and BALP (all P<0.05); No correlation between lumbar spine BMD and various indexes (all P>0.05). ④Multiple linear regression analysis showed that age, BMI, SCr, and PTH were the risk factors affecting BMD of the total hip. Conclusion Compared with the BMD of lumbar spine, BMD of total hip is a sensitive indicator of early bone metabolism abnormality, and gradually decreases with the progress of CKD. BMD of total hip is negatively correlated with P、PTH and BALP. PTH is a risk factor for BMD of total hip. Early combined detection of BMD and bone metabolism biochemical indicators of the total hip has important value for the early detection and management of CKD-MBD.

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