血液透析患者的血管钙化、椎体骨折与死亡率
Vascular calcifications, vertebral fractures and mortality in haemodialysis patients.
作者信息
Rodríguez-García Minerva, Gómez-Alonso Carlos, Naves-Díaz Manuel, Diaz-Lopez Jose Bernardino, Diaz-Corte Carmen, Cannata-Andía Jorge B
机构信息
Bone and Mineral Research Unit, Instituto Reina Sofia de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
出版信息
Nephrol Dial Transplant. 2009 Jan;24(1):239-46. doi: 10.1093/ndt/gfn466. Epub 2008 Aug 25.
BACKGROUND
Vascular calcifications and the bone fractures caused by abnormal bone fragility, also called osteoporotic fractures, are frequent complications associated with chronic kidney diseases (CKD). The aim of this study was to investigate the association between vascular calcifications, osteoporotic bone fractures and survival in haemodialysis (HD) patients.
METHODS
A total of 193 HD patients were followed up to 2 years. Vascular calcifications and osteoporotic vertebral fractures (quoted just as vertebral fractures in the text) were assessed by thoracic, lumbar spine, pelvic and hand X-rays and graded according to their severity. Clinical, biochemical and therapeutic data gathered during the total time spent on HD were collected.
RESULTS
The prevalence of aortic calcifications was higher in HD patients than in a random-based general population (79% versus 37.5%, P < 0.001). Total time on any renal replacement therapy (RRT) and diabetes were positively associated with a higher prevalence of vascular calcifications. In addition to these factors, time on HD was also positively associated with the severity of vascular calcifications, and higher haemoglobin levels were associated with a lower prevalence of severe vascular calcifications in large and medium calibre arteries. The prevalence of vertebral fractures in HD patients was similar to that of the general population (26.5% versus 24.1%). Age and time on HD showed a positive and statistically significant association with the prevalence of vertebral fractures. Vascular calcifications in the medium calibre arteries were associated with a higher rate of prevalent vertebral fractures. In women, severe vascular calcifications and vertebral fractures were positively associated with mortality [RR = 3.2 (1.0-10.0) and RR = 4.8 (1.7-13.4), respectively].
CONCLUSIONS
Positive associations between vascular calcifications, vertebral fractures and mortality have been found in patients on HD.
背景
血管钙化以及由异常骨脆性导致的骨折（也称为骨质疏松性骨折）是慢性肾脏病（CKD）常见的并发症。本研究旨在探讨血液透析（HD）患者血管钙化、骨质疏松性骨折与生存率之间的关联。
方法
共对193例HD患者进行了为期2年的随访。通过胸部、腰椎、骨盆和手部X线检查评估血管钙化和骨质疏松性椎体骨折（文中简称为椎体骨折），并根据严重程度进行分级。收集了HD全过程中的临床、生化和治疗数据。
结果
HD患者主动脉钙化的患病率高于基于随机抽样的普通人群（79% 对37.5%，P < 0.001）。接受任何肾脏替代治疗（RRT）的总时间和糖尿病与血管钙化患病率较高呈正相关。除这些因素外，HD治疗时间也与血管钙化的严重程度呈正相关，较高的血红蛋白水平与大中口径动脉严重血管钙化的患病率较低相关。HD患者椎体骨折的患病率与普通人群相似（26.5% 对24.1%）。年龄和HD治疗时间与椎体骨折的患病率呈正相关且具有统计学意义。中口径动脉的血管钙化与椎体骨折的患病率较高相关。在女性中，严重血管钙化和椎体骨折与死亡率呈正相关[相对危险度（RR）分别为3.2（1.0 - 10.0）和4.8（1.7 - 13.4）]。
结论
HD患者中发现血管钙化、椎体骨折与死亡率之间存在正相关。
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