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不同分期慢性肾脏病患者骨质疏松与心血管钙化的横断面调查

A Cross-sectional Study of Osteoporosis and Cardiovascular Calcification in Patients with Chronic Kidney Disease at Different CKD Stages

    摘要
  • 摘要:
      目的  了解不同分期慢性肾脏病（CKD）患者骨质疏松与心血管钙化的情况，分析其与骨代谢标志物之间的相关性。
      方法  选择2017年7月−2018年1月就诊于重庆医科大学附属第一医院和重庆市涪陵中心医院的368例CKD 3～5期患者，另选60例同期于本院和重庆市涪陵中心医院体检的健康者为对照组。收集所有研究对象入组时的年龄、性别、体质量指数（BMI）；检测估算肾小球滤过率（eGFR）、血清钙（Ca）、磷（P）、白蛋白（ALB）、全段甲状旁腺素（iPTH）、骨性碱性磷酸酶（BALP）、Ⅰ型前胶原氨基端肽（PINP）和β-胶原特殊序列（β-CTX）水平，采用双能X线吸收法和心脏彩色多普勒超声心动图分别检测患者骨质疏松、血管钙化和心脏瓣膜钙化的发生情况；采用胸腹部CT评估所有纳入对象的主动脉及冠状动脉钙化情况。Pearson相关性分析eGFR、血清骨代谢标志物与骨质疏松、心血管钙化之间的相关性。
      结果  与对照组相比，CKD 3～5期组患者血P、iPTH、BALP、PINP、β-CTX水平升高（P<0.05），eGFR、血Ca水平降低（P<0.05），且随着肾功能损害加重，上述指标变化更为明显（P<0.05）；CKD 5期血液透析组患者血管钙化和心脏瓣膜钙化的发生率高于CKD 3～4期组和CKD 5期未透析组（P<0.05）；CKD 3～5期患者的eGFR与血Ca呈正相关（P<0.05），与血P、iPTH、BALP、PINP和β-CTX呈负相关（P<0.05）；CKD 3～5期患者骨质疏松、血管钙化、心脏瓣膜钙化的发生与eGFR和血Ca水平下降呈负相关（P<0.05），与血P、iPTH、BALP、PINP和β-CTX水平增加呈正相关（P<0.05）。
      结论  血清骨代谢标志物和eGFR水平与CKD 3～5期患者骨质疏松和心血管钙化的发生密切相关。

     

    Abstract:
      Objective  To investigate the status of osteoporosis and cardiovascular calcification in patients with chronic kidney disease (CKD) with different stages, and analyze the correlation between the stages and markers of bone metabolism To correlation.
      Methods  A total of 368 CKD patients at stage 3-5 who were treated in First Affiliated Hospital Affiliate to Chongqing Medical University and Chongqing Fuling Central Hospital from July 2017 to January 2018 were enrolled. A total of 60 healthy people who underwent physical examination in the hospital during the same period were enrolled as control group. Age, gender and body mass index (BMI) of all study objects at enrollment time were collected. The levels of estimate glomerular filtration rate (eGFR), serum calcium (Ca), phosphorus (P), albumin (ALB), intact parathyroid hormone (iPTH), bone alkaline phosphatase (BALP), procollagen Ⅰ N-terminal peptide (PINP) and β-crosslaps (β-CTX) were detected. The occurrence of osteoporosis, vascular calcification and heart valve calcification was detected. Pearson correlation analysis was applied to analyze correlation between eGFR, serum bone metabolism markers and osteoporosis, cardiovascular calcification.
      Results  Compared with control group, levels of serum P, iPTH, BALP, PINP and β-CTX were significantly increased in CKD stage 3-5 group (P<0.05), while levels of eGFR and serum Ca were decreased (P<0.05). With the increase of CKD staging, changes of their levels were more significant (P<0.05). The incidence of vascular calcification and heart valve calcification in CKD stage 5 hemodialysis group was higher than that in CKD stage 3-4 group and CKD stage 5 without dialysis group (P<0.05). eGFR was positively correlated with serum Ca in CKD patients at stage 3-5 (P<0.05), while negatively correlated with serum P, iPTH, BALP, PINP and β-CTX (P<0.05). The occurrence of osteoporosis, vascular calcification and heart valve calcification was negatively correlated with increase of eGFR and serum Ca levels in CKD patients at stage 3-5 (P<0.05), while positively correlated with increase of levels of serum P, iPTH, BALP, PINP and β-CTX (P<0.05).
      Conclusion  The levels of serum bone metabolism markers and eGFR are closely related to occurrence of osteoporosis and cardiovascular calcification in CKD patients at stage 3-5.

     

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