终末期肾病患者的骨矿物质密度：与消瘦、心血管疾病及死亡率的关联
Bone mineral density in end-stage renal disease patients: association with wasting, cardiovascular disease and mortality.
作者信息
Matsubara Keisuke, Suliman Mohamed E, Qureshi Abdul Rashid, Axelsson Jonas, Martola Leena, Heimbürger Olof, Barany Peter, Stenvinkel Peter, Lindholm Bengt
机构信息
Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
出版信息
Blood Purif. 2008;26(3):284-90. doi: 10.1159/000126925. Epub 2008 Apr 18.
BACKGROUND
Bone and mineral disorders may contribute to extraosseous ossifications and cardiovascular disease (CVD) in end-stage renal disease (ESRD) patients. We have investigated the relationship between bone mineral density (BMD) and inflammation, wasting, CVD and mortality in ESRD patients.
METHODS
BMD (dual energy X-ray absorptiometry) and biochemical, nutritional and inflammatory markers were assessed in 277 incident ESRD patients (GFR 7.1 +/- 0.2 ml/min) who were then followed prospectively for a mean of 27 (range 1-60) months. Carotid plaques were determined in 103 patients.
RESULTS
Patients with carotid plaques, clinical manifestation of CVD and wasting (assessed by subjective global assessment) had significantly lower BMD than their counterparts. Low BMD was associated with high all-cause and cardiovascular mortality. Even after adjustment for several confounders and risk factors, all-cause (HR = 2.1, CI: 1.1-3.9, p = 0.02) and cardiovascular (HR = 2.8, CI: 1.2-6.3, p = 0.02) mortality remained significantly associated with low BMD.
CONCLUSIONS
Low BMD is associated with wasting and CVD, and is an independent predictor of all-cause and cardiovascular mortality in ESRD patients.
背景
骨与矿物质紊乱可能导致终末期肾病（ESRD）患者出现骨外骨化和心血管疾病（CVD）。我们研究了ESRD患者的骨密度（BMD）与炎症、消瘦、CVD及死亡率之间的关系。
方法
对277例初发ESRD患者（肾小球滤过率7.1±0.2 ml/min）进行BMD（双能X线吸收法）及生化、营养和炎症指标评估，随后对其进行平均27（范围1 - 60）个月的前瞻性随访。对103例患者测定颈动脉斑块情况。
结果
有颈动脉斑块、CVD临床表现及消瘦（通过主观全面评定法评估）的患者其BMD显著低于无上述情况的患者。低BMD与全因死亡率和心血管死亡率升高相关。即使在对多个混杂因素和危险因素进行校正后，全因死亡率（风险比[HR]=2.1，可信区间[CI]：1.1 - 3.9，p = 0.02）和心血管死亡率（HR = 2.8，CI：1.2 - 6.3，p = 0.02）仍与低BMD显著相关。
结论
低BMD与消瘦和CVD相关，是ESRD患者全因死亡率和心血管死亡率的独立预测因素。
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