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目的探讨继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的维持性血液透析患者骨密度及骨代谢特点。方法 156例患者纳入本研究,常规检测透析前血钙、血磷、碱性磷酸酶、C反应蛋白,化学发光法检测血清全段甲状旁腺素(iPTH)、骨钙素(OC)、I型前胶原氨基末端前肽(PINP)、β胶原蛋白水平(β-CTX),双能X线法测定患者骨密度。结果维持性血液透析患者诊断SHPT 66例,非SHPT 90例。SHPT患者较非SHPT患者OC[(197.36±44.19)ng/ml vs.(527.89±85.53)ng/ml,P<0.001],PINP[(327.15±40.40)ng/ml vs.(616.99±125.82)ng/ml,P<0.001]、β-CTX[(1.99±0.16)ng/ml vs.(2.47±0.15)ng/ml,P=0.049]水平增高。SHPT患者较非SHPT患者骨密度结果全身平均BMD值[(1.01±0.12)vs.(0.93±0.14),P=0.017],Z值[(-0.78±0.50)vs.(-1.00±0.79),P=0.043]减低;logistic回归分析,透析前血磷(P=0.000)、OC(P=0.007)、透析龄(P=0.002)是SHPT的独立影响因素。结论全面评估SHPT患者骨代谢指标及骨密度情况,对于患者SHPT骨病的诊断及治疗有着重要意义。
Objective To investigate the features of bone mineral density (BMD) and bone metabolism in maintenance hemodialysis patients with secondary hyperparathyroidism (SHPT). Methods 156 patients were enrolled in this study. Pre-dialysis serum calcium, phosphorus, alkaline phosphatase, C-reactive protein and chemiluminescence method were used to detect serum total parathyroid hormone (iPTH), osteocalcin (OC), I Type procollagen (PINP), beta-collagen (beta-CTX), and dual-energy X-ray. Results In hemodialysis patients, 66 cases were diagnosed as SHPT and 90 cases were non-SHPT. Compared with non-SHPT patients, the number of patients with SHPT was significantly higher than that of patients without OCT [(197.36 ± 44.19) ng / ml vs. (527.89 ± 85.53) ng / ml, P <0.001], PINP [(327.15 ± 40.40) ng / ml vs. (616.99 ± 125.82) ng / ml, P <0.001, β-CTX [(1.99 ± 0.16) ng / ml vs. (2.47 ± 0.15) ng / ml, P = 0.049]. The mean BMD of BMD in patients with SHPT compared with non-SHPT patients [(1.01 ± 0.12) vs. (0.93 ± 0.14), P = 0.017], Z value [-0.78 ± 0.50 vs. (-1.00 ± 0.79) P = 0.043]. Logistic regression analysis showed that pre-dialysis phosphorus (P = 0.000), OC (P = 0.007) and dialysis age (P = 0.002) were independent factors of SHPT. Conclusion The comprehensive assessment of bone metabolic parameters and bone mineral density in SHPT patients is of great significance for the diagnosis and treatment of SHPT bone disease.