摘要目的 探讨非透析慢性肾脏病(CKD)患者骨量异常和血管钙化的危险因素.方法 回顾性分析2013年1月到2014年6月福建医科大学附属第一医院住院的非透析CKD患者的临床资料.采用双能X线吸收测定法检测骨密度(BMD)及确定T值,依据不同T值分为骨量正常组(T值≥-1)、骨量减少组(-2.5 ＜T＜-1)、骨质疏松组(T≤-2.5).采用胸部计算机断层扫描(CT)检查评估是否存在血管钙化.逐步Logistic回归分析评估骨量异常和血管钙化的危险因素.结果共337例CKD患者,其中骨量正常110例(32.6％),骨量减少146例(43.3％),骨质疏松81例(24.0％).3组患者在性别、高血压病史、25羟维生素D及N端骨钙素方面的比较差异存在统计学意义(均P＜ 0.05).3组患者25羟维生素D缺乏的发生率差异有统计学意义(P=0.012),且25羟维生素D缺乏的发生率随骨量的减少而升高(x2=7.100,P=0.008);其余骨代谢指标异常(低血钙、高血磷、全段甲状旁腺素异常)的发生率在3组间的比较差异均无统计学意义(均P＞ 0.05).多因素逐步Logistic回归分析发现全段甲状旁腺素升高(OR=1.938)、BMD低下(OR=1.724)是CKD患者合并血管钙化的危险因素(均P＜0.05);而女性(OR=3.312)、血管钙化(OR=1.742)是CKD患者BMD低下的危险因素(均P＜0.05).结论 全段甲状旁腺素升高和BMD低下是非透析CKD患者血管钙化的危险因素,而女性和血管钙化则是非透析CKD患者BMD低下的危险因素.

abstractsObjective To explore the risk factors of bone density disorder and vascular calcification in non-dialysis chronic kidney disease (CKD) patients.Methods Clinical data of nondialysis CKD patients who were admitted to the First Affiliated Hospital of Fujian Medical University between January 2013 and June 2014 were retrospectively analyzed.Using dual energy X-ray absorptiometry to evaluate their bone mineral density (BMD) and T value.Patients were divided into normal BMD group (T≥-1),osteopenia group (-2.5 ＜ T ＜-1) and osteoporosis group (T≤-2.5).The vascular calcification was evaluated by pectoral computed tomography.Multi-factor stepwise logistic regression analysis was used to assess the risk factors for low bone density and vascular calcification in non-dialysis CKD patients.Results A total of 337 non-dialysis CKD patients were enrolled.There were 110 (32.6％) patients with normal BMD,and 146(43.3％) patients with osteopenia,and 81(24.0％) patients with osteoporosis.Gender,history of hypertension,25-hydroxy vitamin D and N-terminal osteocalcin shown statistical differences among three groups (all P ＜ 0.05).The incidence rate of 25-hydroxy vitamin D deficiency shown statistical difference among three groups (P=0.012).Further,the rates were increased with the decreased bone mass (x2=7.100,P=0.008).The other mineral bone disorders,such as hypocalcemia,hyperphosphatemia,low intact parathyroid hormone (iPTH) and high iPTH had no statistical difference among three groups (all P ＞ 0.05).Multi-factor stepwise logistic regression analysis revealed that increased iPTH (OR=1.938),and low bone density (OR=1.724) were independent risk factors for CKD patients with vascular calcification (all P ＜ 0.05),while women (OR=3.312) and vascular calcification (OR=1.742) were independent risk factors for CKD patients with low bone density (all P ＜ 0.05).Conclusion Increased iPTH and low bone density are independent risk factors for non-dialysis CKD patients with vascular calcification,while women and vascular calcification are independent risk factors for non-dialysis CKD patients with low bone density.