Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
BMC Nephrol. 2019 Feb 18;20(1):59. doi: 10.1186/s12882-019-1235-z.
Risk of cardiac events and cardiovascular disease (CVD) in end-stage renal disease (ESRD) patients are predicted by coronary artery calcification (CAC) independently. It is not clear to what extent low bone mineral density (BMD) is associated with higher risk of CAC and if sex interacts. We investigated the sex-specific associations of CAC score with total body BMD (tBMD) as well as with BMD of different skeletal sub-regions.
In 174 ESRD patients, median age 57 (10th-90th percentiles 29-75) years, 63% males, BMD (measured by dual-energy X-ray absorptiometry; DXA), CAC score (measured by cardiac CT) and circulating inflammatory biomarkers were analysed.
A total of 104 (60%) patients with CAC > 100 AUs were older, had higher prevalence of both clinical CVD and diabetes, higher level of high sensitivity C-reactive protein, tumour necrosis factor, interleukin-6 and lower T-score of tBMD. Female patients had significantly lower tBMD and BMD of all skeletal sub-regions, except head, than male patients. Female patients with high CAC (> 100 AUs) had significantly decreased T-score of tBMD, and lower BMD of arms, legs than those low CAC (≤ 100 AUs); elevated CAC score were associated with tBMD, T-score, Z-score of tBMD and BMD of arms and legs, while no such differences was observed in males. Multivariate generalized linear model (GLM) analysis adjusted for age, diabetes and hsCRP showed that in females per SD higher CAC score (1057 AUs) was predicted by either per SD (0.13 g/cm) lower tBMD or per SD (0.17 g/cm) lower BMD at legs. No such associations were found in male ESRD patients.
In female, but not male, lower BMD, in particular sub-regions of legs, was associated with higher CAC score independently. Low BMD has the potential to identify increased risk for high CAC score in ESRD patients.
在终末期肾病（ESRD）患者中，心脏事件和心血管疾病（CVD）的风险可通过冠状动脉钙化（CAC）独立预测。低骨密度（BMD）与 CAC 风险增加的相关性程度以及性别是否存在相互作用尚不清楚。我们研究了 CAC 评分与全身骨密度（tBMD）以及不同骨骼亚区 BMD 的性别特异性关联。
在 174 名 ESRD 患者中，中位年龄 57 岁（第 10 至 90 个百分位数为 29 至 75 岁），63%为男性，通过双能 X 射线吸收法（DXA）测量 BMD，通过心脏 CT 测量 CAC 评分，并分析循环炎症生物标志物。
共有 104 名（60%）CAC > 100 AU 的患者年龄更大，患有临床 CVD 和糖尿病的比例更高，高敏 C 反应蛋白、肿瘤坏死因子、白细胞介素 6 水平更高，tBMD 的 T 评分更低。女性患者的 tBMD 和所有骨骼亚区的 BMD，除头部外，均显著低于男性患者。CAC 较高（> 100 AU）的女性患者 tBMD 的 T 评分显著降低，BMD 的手臂、腿部低于 CAC 较低（≤ 100 AU）的患者；升高的 CAC 评分与 tBMD、T 评分、tBMD 的 Z 评分和手臂及腿部的 BMD 相关，而在男性中则没有观察到这种差异。经过年龄、糖尿病和 hsCRP 调整的多变量广义线性模型（GLM）分析表明，在女性中，每增加一个标准差（SD）的 CAC 评分（1057 AU）与每增加一个标准差（0.13 g/cm）的 tBMD 或每增加一个标准差（0.17 g/cm）的腿部 BMD 呈负相关。在男性 ESRD 患者中没有发现这种相关性。
在女性中，但不是男性中，较低的 BMD，特别是腿部的亚区，与 CAC 评分的增加独立相关。低 BMD 有可能识别出 ESRD 患者 CAC 评分升高的高风险。
