Shen Yuwen, Hua Qing, Pan Xinyu, Xie Ping, Zhang Lianwei, Wu Linhe, Yang Sitong, Ren Wen, Liu Kefu
Department of Medical Imaging, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School of Nanjing Medical University, No.242, GuangJi Road, Suzhou, 215008, Jiangsu, China.
Department of Nephrology, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School of Nanjing Medical University, Suzhou, 215008, Jiangsu, China.
Sci Rep. 2025 Jul 1;15(1):21038. doi: 10.1038/s41598-025-07025-2.
This study was aimed to investigate the evolution of bone mineral density (BMD) in patients with maintenance hemodialysis (MHD) by using phantom-less quantitative computed tomography (PL-QCT). We collected patients with MHD in Suzhou Hospital of Nanjing Medical University from September 2020 to December 2023 as the prospective observation group. BMD of thoracolumbar vertebra, total hip and femoral neck were measured by PL-QCT. Patients with MHD were divided into 9 groups according to hemodialysis duration. Chest CT scans of patients in prospective observation group were collected during the first three months of MHD and 1 year, 2 years, 3 years after dialysis between January 2017 and December 2023 as the retrospective observation group, and BMD of the twelfth thoracic vertebra was measured. According to the BMD changes among the prospective observation group and the retrospective observation group, the evolution of thoracolumbar vertebral BMD, whole hip BMD and femoral neck BMD were comprehensively analyzed. BMD of thoracolumbar vertebra gradually decreased within 36 months in patients with MHD. Thoracolumbar vertebral BMD tended to increase when hemodialysis duration was more than 36-48 months, and thoracolumbar vertebral BMD increased significantly with hemodialysis duration when hemodialysis duration was more than 60 months, and significantly exceeded the BMD before MHD. BMD of total hip and femoral neck gradually decreased within 36 months in patients with MHD. BMD of total hip and femoral neck increased with hemodialysis duration when hemodialysis duration was more than 72 months, but was almost the same as that of the first year of MHD. In the follow-up evaluation of BMD in MHD patients, it is recommended to use QCT to measure BMD in thoracolumbar vertebrae or hip the first 3 years of MHD, and use QCT to measure BMD in thoracolumbar vertebrae to evaluate changes over 5 years of MHD.
本研究旨在利用无体模定量计算机断层扫描（PL-QCT）研究维持性血液透析（MHD）患者骨密度（BMD）的变化情况。我们收集了2020年9月至2023年12月在南京医科大学附属苏州医院的MHD患者作为前瞻性观察组。采用PL-QCT测量胸腰椎、全髋和股骨颈的骨密度。MHD患者根据血液透析时长分为9组。收集前瞻性观察组患者在2017年1月至2023年12月期间MHD开始的前三个月以及透析后1年、2年、3年的胸部CT扫描作为回顾性观察组，并测量第十二胸椎的骨密度。根据前瞻性观察组和回顾性观察组之间的骨密度变化，综合分析胸腰椎骨密度、全髋骨密度和股骨颈骨密度的变化情况。MHD患者胸腰椎骨密度在36个月内逐渐下降。当血液透析时长超过36 - 48个月时，胸腰椎骨密度有上升趋势，当血液透析时长超过60个月时，胸腰椎骨密度随透析时长显著增加，且显著超过MHD前的骨密度。MHD患者全髋和股骨颈骨密度在36个月内逐渐下降。当血液透析时长超过72个月时，全髋和股骨颈骨密度随透析时长增加，但与MHD第一年时几乎相同。在MHD患者骨密度的随访评估中，建议在MHD的前3年使用QCT测量胸腰椎或髋部的骨密度，在MHD超过5年时使用QCT测量胸腰椎骨密度以评估变化情况。
