摘要
目的:评估维持性透析患者骨质疏松的危险因素,探索其潜在的预测因子。方法:纳入2023年5月至2023年12月在宁波市医疗中心李惠利医院进行维持性透析治疗的患者225例(其中包括血透患者109例,腹透患者116例)。采用双能X线骨密度仪测量腰椎、髋关节骨密度。根据骨密度将患者分为骨量正常组、骨量减少组和骨质疏松组,比较3组患者间的一般资料、实验室检查、骨代谢标志物及调节因子水平差异;采用Pearson或Spearman相关分析评估临床资料与腰椎、髋关节骨密度的相关性;通过单因素和多因素Logistic回归分析评估维持性透析患者骨质疏松的危险因素;筛选维持性透析患者骨质疏松潜在的预测因子,并采用ROC曲线评估其预测效能。结果:3组患者中,骨质疏松组患者更高龄,女性比例更高,血透比例更高,透析龄更长,且具有更高的HDL-C、骨保护素(OPG)、P1NP和β-CTX,而BMI、肌酐、尿素氮和血磷则更低(均P<0.05)。相关分析结果显示,腰椎和髋关节骨密度均与BMI、肌酐呈正相关,与透析龄、HDL-C、OPG、P1NP、β-CTX呈负相关(均P<0.05)。以发生骨质疏松为因变量,将单因素Logistic回归分析中有显著相关性的变量年龄、性别、BMI、透析龄、透析方式、肌酐、尿素氮、血磷、甘油三酯、LDL-C、HDL-C、碱性磷酸酶、OPG、RANKL、P1NP和β-CTX(均P<0.1)纳入多因素Logistic回归分析,结果显示,高龄和高OPG是维持性透析患者发生骨质疏松的独立危险因素(均P<0.05)。ROC曲线分析表明,OPG预测透析患者骨质疏松的AUC为0.718(95%CI=0.638~0.798,P<0.001),最佳截断值为2133.7 pg/mL,其灵敏度为45.7%,特异度为90.2%;年龄预测透析患者骨质疏松的AUC为0.675(95%CI=0.596~0.755,P<0.001),最佳截断值为57.5岁,其灵敏度为67.2%,特异度为57.9%。两者联合预测透析患者骨质疏松的AUC为0.743(95%CI=0.670~0.817,P<0.001)。结论:在维持性透析患者中,高龄、高OPG是骨质疏松的独立危险因素;OPG是较有潜力的透析患者骨质疏松的预测因子,联合年龄可以进一步提升预测能力。
Objective:To evaluate risk factors for osteoporosis in maintenance dialysis patients and identify potential predictors.Methods:A total of 225 patients(109 undergoing hemodialysis and 116 undergoing peritoneal dialysis)receiving maintenance dialysis at Ningbo Medical Center Lihuili Hospital from May 2023 to December 2023 were included.Bone mineral density(BMD)of the lumbar spine and total hip was measured by dual-energy X-ray absorptiometry.Patients were stratified into normal bone mass,decreasing bone mass,and osteoporosis groups based on BMD.Differences in general data,laboratory examination,bone metabolism markers,and regulatory factors among groups were analyzed.Pearson or Spearman correlation analysis was used to evaluate the correlation between clinical data and BMD of the lumbar spine and total hip.Univariate and multivariate logistic regression analysis was conducted to evaluate the risk factors of osteoporosis in maintenance dialysis patients.Potential predictors of osteoporosis were screened,and their predictive efficacy was assessed by ROC curve analysis.Results:Among the three groups,the osteoporosis group exhibited older age,a higher proportion of females,a greater prevalence of hemodialysis,longer dialysis duration,elevated HDL-C,increased levels of osteoprotegerin(OPG),P1NP,andβ-CTX,as well as lower BMI,creatinine,urea nitrogen,and blood phosphorus(all P<0.05).Correlation analysis showed that BMD of the lumbar spine and total hip was positively correlated with BMI and creatinine,but negatively correlated with dialysis age,HDL-C,OPG,P1NP,andβ-CTX(all P<0.05).Using osteoporosis as the dependent variable,variables with significant correlation in univariate Logistic regression analysis including age,gender,BMI,dialysis age,dialysis mode,creatinine,urea nitrogen,blood phosphorus,triglyceride,LDL-C,HDL-C,alkaline phosphatase,OPG,RANKL,P1NP,andβ-CTX(all P<0.1)were performed for multivariate logistic regression analysis.The results showed that old age and high OPG were independent risk factors for osteoporosis in maintenance dialysis patients(all P<0.05).ROC curve analysis showed that the AUC of OPG for predicting osteoporosis in dialysis patients was 0.718(95%CI=0.638-0.798,P<0.001)and the best cutoff value was 2133.7 pg/mL,with the sensitivity and the specificity being 45.7%and 90.2%,respectively.Age-predicted AUC for osteoporosis in dialysis patients was 0.675(95%CI=0.596-0.755,P<0.001),and the optimal cut-off was 57.5 years,with the sensitivity and the specificity being 67.2%and 57.9%,respectively.The combined prediction of AUC for osteoporosis in dialysis patients was 0.743(95%CI=0.670-0.817,P<0.001).Conclusion:Old age and high OPG are independent risk factors for osteoporosis in maintenance dialysis patients.OPG is a promising predictor of osteoporosis in dialysis patients and,if combined with age,can further improve the predictive power.
作者
高依依
徐鹏杰
仉超
王江东
夏巧静
吴永耀
施立华
金雷钢
刘江
GAO Yiyi;XU Pengjie;ZHANG Chao;WANG Jiangdong;XIA Qiaojing;WU Yongyao;SHI Lihua;JIN Leigang;LIU Jiang(Department of Nephrology,Ningbo Medical Center Lihuili Hospital(the Affiliated Lihuili Hospital of Ningbo University),Ningbo 315040,China;Department of Pharmacy,the First People’s Hospital of Xiaoshan District,Hangzhou 311200,China;State Key Laboratory of Pharmaceutical Biotechnology,Department of Medicine,the University of Hong Kong,Hong Kong 999077,China)
出处
《温州医科大学学报》
2025年第8期660-666,共7页
Journal of Wenzhou Medical University
关键词
肾透析
骨质疏松
骨保护素
危险因素
预测分析
renal dialysis
osteoporosis
osteoprotegerin
risk factors
predictive analysis
