河北医科大学学报 ›› 2022, Vol. 43 ›› Issue (7): 763-767.doi: 10.3969/j.issn.1007-3205.2022.07.005

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老年慢性肾衰竭维持性血液透析患者褪黑素、AOPP水平与骨质疏松症的关系研究

  

  1. 1.江苏省淮安市第一人民医院肾内科，江苏 淮安 223300；2.江苏省淮安市第一人民医院骨科，江苏 淮安 223300；3.华北理工大学附属医院肾内科，河北 唐山 063000

  • 出版日期:2022-07-25 发布日期:2022-07-26
  • 作者简介:卢海源（1986-），女，河北唐山人，江苏省淮安市第一人民医院主治医师，医学硕士,从事肾病诊治研究。
  • 基金资助:
    江苏省自然科学基金（BK20170369）

Study on the relationship between melatonin, AOPP levels and osteoporosis in elderly patients with chronic renal failure undergoing maintenance hemodialysis

  1. 1.Department of Nephrology, the First People′s Hospital of Huaian City, Jiangsu Province, Huaian 
    223300, China; 2.Department of Orthopedics, the First People′s Hospital of Huaian City, Jiangsu 
    Province, Huaian 223300, China； 3.Department of Nephrology, Affiliated Hospital of North 
    China University of Science and Technology， Hebei  Province， Tangshan  063000, China

  • Online:2022-07-25 Published:2022-07-26

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摘要： 目的 分析老年慢性肾衰竭维持性血液透析患者褪黑素（melatonin，MT）、高级氧化蛋白产物（advanced oxidized protein products，AOPP）水平与骨质疏松症的关系。
方法 选取我院收治的老年慢性肾衰竭维持性血液透析患者105例，统计骨质疏松症发病率，比较骨质疏松症患者和非骨质疏松症患者血清MT、AOPP水平和骨密度，老年慢性肾衰竭维持性血液透析患者血清MT、AOPP水平与骨密度的关系进行Pearson相关性分析，老年慢性肾衰竭维持性血液透析患者骨质疏松的影响因素进行Logistic回归分析。采用受试者工作特征曲线（receiver operating curve，ROC）分析血清MT、AOPP水平预测老年慢性肾衰竭维持性血液透析患者骨质疏松的效能。
结果 慢性肾衰竭维持性血液透析患者骨质疏松症发生率为45.71%；骨质疏松症患者血清AOPP水平均高于非骨质疏松症患者（P＜0.05），血清MT水平和骨密度（腰椎L1~4和双侧股骨颈和Ward′s氏）均低于非骨质疏松症患者（P＜0.05）；Pearson相关性分析结果显示，老年慢性肾衰竭维持性血液透析患者血清AOPP水平与不同部位骨密度均呈负相关（P＜0.05），血清MT水平与不同部位骨密度均呈正相关（P＜0.05）；骨质疏松症患者血清骨钙素、透析龄水平与与非骨质疏松症患者比较，差异有统计学意义（P＜0.05）；Logistic多因素回归分析显示透析龄、血清AOPP、MT、性别均是老年慢性肾衰竭维持性血液透析患者骨质疏松的独立危险因素（P＜0.05）。ROC分析显示，MT、AOPP水平预测老年慢性肾衰竭维持性血液透析患者骨质疏松的最佳截断点为90.99 μmol/L和21.66 ng/L，曲线下面积（area under the curve，AUC）分别为0.859和0.713。
结论 老年慢性肾衰竭维持性血液透析患者血清AOPP水平异常升高，血清MT水平和骨密度异常降低，血清AOPP、MT水平与老年慢性肾衰竭维持性血液透析患者骨密度相关，且二者均可作为预测患者骨质疏松症敏感指标。


关键词: 肾功能不全, 肾透析, 褪黑激素

Abstract: Objective To analyze the relationship between the levels of melatonin(MT), advanced oxidized protein product(AOPP) and osteoporosis in elderly patients with chronic renal failure(CRF) undergoing maintenance hemodialysis.
Methods A total of 105 elderly patients with CRF undergoing maintenance hemodialysis in our hospital were enrolled. The incidence of osteoporosis was calculated, and the serum MT, AOPP levels and bone mineral density between osteoporosis patients and non-osteoporosis patients were compared. Pearson correlation analysis was performed on the relationship between serum MT and AOPP levels and bone mineral density in elderly patients with CRF undergoing maintenance hemodialysis. Logistic regression analysis was performed on the factors affecting osteoporosis in elderly patients with CRF undergoing maintenance hemodialysis. The receiver operating characteristic(ROC) curve was used to analyze the efficacy of serum MT and AOPP levels in predicting osteoporosis in elderly patients with CRF undergoing maintenance hemodialysis. 
Results The incidence of osteoporosis in patients with CRF undergoing maintenance hemodialysis was 45.71%. The serum AOPP level of osteoporosis patients was higher than that of non-osteoporosis patients(P＜0.05), and the serum MT level and bone density(lumbar spine L1-4 and bilateral femoral neck and Ward′s area) were lower than those of non-osteoporosis patients(P＜0.05). The results of Pearson correlation analysis showed that serum AOPP levels in elderly patients with CRF undergoing maintenance hemodialysis were negatively correlated with bone mineral density in different areas(P＜0.05), and serum MT levels were positively correlated with bone mineral density in different areas(P＜0.05). Compared with non-osteoporotic patients, the serum osteocalcin levels and dialysis age of osteoporosis patients had statistically significant differences(P＜0.05). Logistic multivariate regression analysis showed that serum dialysis age, AOPP, MT,and gender were independent risk factors for osteoporosis in elderly patients with CRF undergoing maintenance hemodialysis(P＜0.05). ROC analysis showed that the optimal cut-off points of MT and AOPP levels for predicting osteoporosis in elderly patients with CRF undergoing maintenance hemodialysis were 90.99 μmol/L and 21.66 ng/L respectively, and the area under the curve(AUC) was 0.859 and 0.713 respectively. 
Conclusion Elderly patients with CRF undergoing maintenance hemodialysis have abnormally increased serum AOPP levels, and abnormally decreased serum MT levels and bone mineral density. Serum AOPP and MT levels are correlated with bone mineral density in elderly patients with CRF undergoing maintenance hemodialysis, which can be used as sensitive indicators to predict osteoporosis in CRF patients. 


Key words: renal insufficiency, renal dialysis, melatonin

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