Johnson D W, McIntyre H D, Brown A, Freeman J, Rigby R J
Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia.
Perit Dial Int. 1996 Jan-Feb;16(1):34-40.
The aims of this study were to assess the clinical utility of total and regional bone densitometry in a large continuous ambulatory peritoneal dialysis (CAPD) population and to determine the clinical, biochemical, and radiographic variables that best identified osteopenic CAPD patients.
A cross-sectional study was performed on 45 CAPD patients (19 males, 26 females), comprising the total CAPD population at the Princess Alexandra Hospital.
Total body (TB), anteroposterior lumbar spine (APL), femoral neck (FN), Ward's triangle (WT), and skull bone mineral densities (BMDs) were measured using dual-energy x-ray absorptiometry (DEXA) and then correlated with clinical, biochemical, and radiographic indices of uremic osteodystrophy.
BMDs were not significantly different from age- and sex-matched reference population data. Considerable regional variation of BMD Z scores were noted between FN (-0.11 +/- 0.23), WT (-0.11 +/- 0.22), and APL (1.22 +/- 0.04) (p = 0.003). APLZ scores were significantly reduced in patients with a previous history of fracture (-1.36 +/- 1.07 vs 0.89 +/- 0.31), bone pain (-0.72 +/- 1.08 vs 1.01 +/- 0.31), or steroid treatment (-0.62 +/- 0.39 vs 1.16 +/- 0.35). Increased BMD Z scores for APL (1.82 +/- 0.57 vs 0.38 +/- 0.29, p < 0.05), FN (0.32 +/- 0.36 vs -0.38 +/- 0.29, p = 0.014), and WT (0.45 +/- 0.38 vs -0.45 +/- 0.26, p < 0.05) were found in patients with radiographic hyperparathyroid bone disease. Both APL BMD Z scores and skull BMDs were weakly correlated with PTH (r = -0.33, p < 0.05 and r = -0.33, p < 0.05, respectively) and with CAPD duration (r = 0.30, p < 0.05 and r = -0.30, p < 0.05). Generally, however, total body and regional BMDs were poorly related to age, renal disease type, dialysis duration, renal failure duration, serum aluminum, calcium, phosphate, alkaline phosphatase, osteocalcin, and parathyroid hormone.
We conclude that the prevalence of osteopenia is not increased in CAPD patients. Clinical and biochemical parameters do not reliably predict BMD measurements, but prior steroids and bone symptoms are major risk factors for important bone loss. Although DEXA can reliably detect osteopenia in different skeletal regions, its usefulness in detecting osteodystrophy is limited by the confounding effects of superimposed hyperparathyroid osteosclerosis, which increases BMD.
本研究旨在评估在大量持续性非卧床腹膜透析（CAPD）患者中全身和局部骨密度测定的临床实用性，并确定最能识别骨质疏松性CAPD患者的临床、生化和影像学变量。
对45例CAPD患者（19例男性，26例女性）进行了一项横断面研究，这些患者来自亚历山德拉公主医院的全部CAPD患者群体。
使用双能X线吸收法（DEXA）测量全身（TB）、腰椎前后位（APL）、股骨颈（FN）、沃德三角（WT）和颅骨骨矿物质密度（BMD），然后将其与尿毒症骨营养不良的临床、生化和影像学指标进行关联分析。
BMD与年龄和性别匹配的参考人群数据无显著差异。在FN（-0.11±0.23）、WT（-0.11±0.22）和APL（1.22±0.04）之间观察到BMD Z值存在显著的区域差异（p = 0.003）。既往有骨折史（-1.36±1.07 vs 0.89±0.31）、骨痛（-0.72±1.08 vs 1.01±0.31）或接受过类固醇治疗（-0.62±0.39 vs 1.16±0.35）的患者，其APL Z值显著降低。在有影像学甲状旁腺功能亢进性骨病的患者中，APL的BMD Z值（1.82±0.57 vs 0.38±0.29，p < 0.05）、FN的BMD Z值（0.32±0.36 vs -0.38±0.29，p = 0.014）和WT的BMD Z值（0.45±0.38 vs -0.45±0.26，p < 0.05）均升高。APL的BMD Z值和颅骨BMD与甲状旁腺激素（PTH）均呈弱相关（分别为r = -0.33，p < 0.05和r = -0.33，p < 0.05），与CAPD治疗时间也呈弱相关（分别为r = 0.30，p < 0.05和r = -0.30，p < 0.05）。然而，总体而言，全身和局部BMD与年龄、肾病类型、透析时间、肾衰竭时间、血清铝、钙、磷、碱性磷酸酶、骨钙素和甲状旁腺激素的相关性较差。
我们得出结论，CAPD患者中骨质疏松症的患病率并未增加。临床和生化参数不能可靠地预测BMD测量结果，但既往使用类固醇和骨症状是重要骨质流失的主要危险因素。虽然DEXA可以可靠地检测不同骨骼区域的骨质疏松症，但其在检测骨营养不良方面的实用性受到叠加的甲状旁腺功能亢进性骨硬化症的混杂影响的限制，这种骨硬化症会增加BMD。
