ISSN 1004-4140
CN 11-3017/P

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

定量CT分析维持性血液透析患者体质成分

吕磊 翟建 李云成 赵亚子 刘艳

吕磊, 翟建, 李云成, 等. 定量CT分析维持性血液透析患者体质成分[J]. CT理论与应用研究, 2022, 32(0): 1-8. DOI: 10.15953/j.ctta.2022.050
引用本文: 吕磊, 翟建, 李云成, 等. 定量CT分析维持性血液透析患者体质成分[J]. CT理论与应用研究, 2022, 32(0): 1-8. DOI: 10.15953/j.ctta.2022.050
LV L, ZHAI J, LI Y C, et al. Quantitative CT analysis of body composition in maintenance hemodialysis patients[J]. CT Theory and Applications, 2022, 32(0): 1-8. DOI: 10.15953/j.ctta.2022.050. (in Chinese)
Citation: LV L, ZHAI J, LI Y C, et al. Quantitative CT analysis of body composition in maintenance hemodialysis patients[J]. CT Theory and Applications, 2022, 32(0): 1-8. DOI: 10.15953/j.ctta.2022.050. (in Chinese)

定量CT分析维持性血液透析患者体质成分

doi: 10.15953/j.ctta.2022.050
详细信息
    作者简介:

    吕磊:男,皖南医学院影像医学与核医学专硕研究生,主要从事CT及MRI诊断,E-mail:1416880062@qq.com

    翟建:男,皖南医学院弋矶山医院教授、主任医师、硕士研究生导师,主要从事颅脑MRI诊断及研究,E-mail:yjszhaij@126.com

    通讯作者:

    翟建*,男,皖南医学院弋矶山医院教授,主任医师,硕士研究生导师,主要从事颅脑MRI诊断及研究,E-mail:yjszhaij@126.com

Quantitative CT Analysis of Body Composition in Maintenance Hemodialysis Patients

  • 摘要: 目的:分析维持性血液透析患者的体成分信息,探讨QCT技术的应用价值。方法:选取本院维持性血液透析患者共62例,根据不同的透析时长分为3组,运用定量CT技术测定患者的骨密度值、腹部脂肪及肌肉含量,同时选取性别及年龄相匹配的健康体检人群62例进行对比分析。结果:透析组骨质疏松者占17.70%(11例),骨量减少者占30.60%(19例),健康对照组,骨质疏松及骨量减少者分别占6.50%(4例)和16.10%(10例),两组间的差异具有统计学意义;透析组的腹内脂肪和皮下脂肪含量分别为(113.70±63.29)cm2、(80.65±59.67)cm2,均低于健康对照组(135.90±58.80)cm2、(122.26±54.94)cm2,透析组L3-SMA<对照组 L3-SMA,(107.00±30.70)cm2<(121.37±32.87)cm2,均具有统计学差异;在不同性别透析患者中,男性透析患者的腰椎骨密度值为(156.11±51.94)(mg/cm3),与女性(124.29±50.89)(mg/cm3)比较,差异有统计学意义;女性患者的皮下脂肪含量要高于男性,而男性和女性的腹腔内脂肪含量差异无统计学意义;透析组的骨密度值和L3-SMA变化与透析时间长短无差异。结论:维持性血液透析患者的骨质疏松症发病率高于健康人群,腹部脂肪及肌肉含量低于健康人群,定量CT对体质成分监测的准确性和敏感性较高。

     

  • 图  1  QCT测量L3中心层面腹部脂肪

    绿色光圈外蓝色代表皮下脂肪含量,光圈内则代表腹腔内脂肪含量。

    Figure  1.  QCT measures abdominal fat at the center level of L3

    图  2  测量L1、L2椎体松质骨骨密度值

    Figure  2.  Measure the bone density values of L1 and L2 vertebral body cancellous bones

    图  3  示意图,图中勾画的彩色区域即为L3-SMA

    Figure  3.  Schematic diagram, the colored area outlined in the figure is L3-SMA

    图  4  实测图,绿色光圈内的区域面积相加即得到L3-SMA

    Figure  4.  Measured diagram, the area of the region within the green aperture is added together and the L3-SMA is obtained

    表  1  健康人群与透析患者骨量状况比较

    Table  1.   Comparison of bone mass status of healthy population and dialysis patients      

    组别骨量状况总计
    骨量正常骨量减少骨质疏松
    对照组48(77.40%)10(16.10%)4(6.5%)62(100%)
    透析组32(51.60%)19(30.60%)11(17.70%)62(100%)
    下载: 导出CSV

    表  2  健康人群与透析患者腹部脂肪及L3水平横断面肌肉面积比较($\bar x \pm s $

    Table  2.   Comparison of abdominal fat and L3-SMA between healthy population and dialysis patients ($\bar x \pm s $

    项目透析组对照组P
    腹内脂肪/cm2      113.70±63.29135.90±58.80<0.05
    皮下脂肪/cm2      80.65±59.67122.26±54.94<0.05
    L3水平横断面肌肉面积/cm2107.00±30.70121.37±32.87<0.05
    下载: 导出CSV

    表  3  不同性别血透患者骨密度及腹部脂肪比较($\bar x \pm s $

    Table  3.   Comparison of bone density and abdominal fat in hemodialysis patients of different sexes ($\bar x \pm s $

    组别骨密度/(mg/cm3腹内脂肪/cm2皮下脂肪/cm2
    男(n=33)156.11±51.94100.97±58.8163.47±54.02
    女(n=29)124.29±50.89128.18±66.07100.20±60.34
    P<0.05>0.05<0.05
    下载: 导出CSV

    表  4  透析患者骨密度及L3水平横断面肌肉面积与透析时间的变化规律($\bar x \pm s $

    Table  4.   Variation of bone density and L3-SMA and dialysis time in dialysis patients ($\bar x \pm s $

    项目透析时间
    <2年(n=19)2~5年(n=23)>5年(n=20)
    骨密度/(mg/cm3)    132.17±52.21134.14±58.36157.99±47.10
    L3水平横断面肌肉面积/cm2115.91±42.16103.10±23.65103.03±24.07
    下载: 导出CSV
  • [1] ZAYOUR D, DAOUK M, MEDAWAR W, et a1. Predictors of bone mineral, density in patients on hemodialysis[J]. TranspIanlation Proceedings, 2004, 36(5): 1297−1301. doi: 10.1016/j.transproceed.2004.05.069
    [2] WU C C, LIOU H H, SU P F, et al. Abdominal obesity is the most significant metabolic syndrome component predictive of cardiovascular events in chronic hemodialysis patients[J]. Nephrol Dial Transplant, 2011, 26: 3689−3695. doi: 10.1093/ndt/gfr057
    [3] 程晓光, 王亮, 曾强, 等. 中国定量CT (QCT)骨质疏松症诊断指南(2018)[J]. 中国骨质疏松杂志, 2019,25(6): 733−737.

    CHENG X G, WANG L, ZENG Q, et al. The China guideline for the diagnosis criteria of oste oporosis with quantitative computed tomography (QCT) (2018)[J]. Chinese Journal of Osteoporosis, 2019, 25(6): 733−737. (in Chinese).
    [4] 夏维波, 章振林, 林华, 等. 原发性骨质疏松症诊疗指南(2017)[J]. 中国骨质疏松杂志, 2019,25(3): 281−309. doi: 10.3969/j.issn.1006-7108.2019.03.001

    XIA W B, ZHANG Z L, LIN H, et al. Guidelines for the diagnosis and management of primary osteoporosis (2017))[J]. Chinese Journal of Osteoporosis, 2019, 25(3): 281−309. (in Chinese). doi: 10.3969/j.issn.1006-7108.2019.03.001
    [5] 胡耀, 黄朝莉, 徐秀蓉. 维持性血液透析患者骨密度测定与相关指标分析[J]. 现代临床医学, 2012,38(1): 13−14. doi: 10.3969/j.issn.1673-1557.2012.01.005

    HU Y, HUANG Z L, XU X R. To analysis bone mineral density and related indicators in patients of maintaining hemodialysis[J]. Journal of Modern Clinical Medicine, 2012, 38(1): 13−14. (in Chinese). doi: 10.3969/j.issn.1673-1557.2012.01.005
    [6] MOSCOVICI A, SPRAGUE S M. Osteoprosis and chronic kidney disease[J]. Seminars in Dialysis, 2007, 20(5): 423−430. doi: 10.1111/j.1525-139X.2007.00319.x
    [7] 刘铁滨, 王维. 长期血液透析患者腰椎骨密度定量CT的检测及意义[J]. 实用放射学杂志, 2004,20(12): 1104−106. doi: 10.3969/j.issn.1002-1671.2004.12.014

    LIU T B, WANG W. Measurement of lumbar bone mineral density with quantitative computed tomography in hemodialysis patients[J]. Journal of Practical Radiology, 2004, 20(12): 1104−106. (in Chinese). doi: 10.3969/j.issn.1002-1671.2004.12.014
    [8] MIRFAKHRAEE S, SAKHAEE K, ZERWEKH J, et al. Risk factors for diminished bone mineral density among male hemodialysis patients: A cross-sectional study[J]. Arch Osteoporos, 2012, 7(1/2): 283−290. doi: 10.1007/s11657-012-0110-3
    [9] SHEU Y, MARSHALL L M, HOLTON K F, et al. Abdominal body composition measured by quantitative computed tomography and risk of non-spine fractures: the osteoporotic fractures in men (MrOS) study[J]. Osteoporosis International, 2013, 24(8): 2231−2241. doi: 10.1007/s00198-013-2322-9
    [10] CHENG X, ZHANG Y, WANG C, et al. The optimal anatomic sitefor a single slice to estimate the total volume of visceraladipose tissue by using the quantitative computedtomography (QCT) in Chinese population[J]. European Journal of Clinical Nutrition, 2018, 72(11): 1567−1575. doi: 10.1038/s41430-018-0122-1
    [11] 丁奕, 田娜, 周晓玲, 等. 肥胖与IgA肾病患者独立肾脏风险因子的相关性分析[J]. 中华肾脏病杂志, 2017,33(5): 321−326. doi: 10.3760/cma.j.issn.1001-7097.2017.05.001

    DING Y, TIAN N, ZHOU X L, et al. Correlation analysis of obesity with independent renal risk factors in patients with IgA nephropathy[J]. Chinese Journal of Nephrology, 2017, 33(5): 321−326. (in Chinese). doi: 10.3760/cma.j.issn.1001-7097.2017.05.001
    [12] 刘建强, 贾冶, 许钟镐, 等. 肥胖与慢性肾脏疾病: 脂肪组织与肾脏炎症及纤维化的关系[J]. 中华肾脏病杂志, 2017, 33(12): 956-960.

    LIU J Q, JIA Y, XU Z H, et al. Obesity and chronic kidney disease: The relationship between adipose tissue and kidney inflammation and fibrosis[J]. Chinese Journal of Nephrology, 2017, 33(12): 956-960. (in Chinese).
    [13] 罗文荣, 姚书东, 孙梅琴. 血液透析对肾病肥胖女性患者内分泌相关指标的影响[J]. 中国妇幼保健, 2021,36(14): 3195−3198. DOI: 10.19829/j.zgfybj.issn.1001-4411.2021.14.009.

    LUO W R, YAO S D, SUN M Q. Effect of hemodialysis on endocrine-related indicators in obese women with kidney disease[J]. Maternal and Child Health Care of China, 2021, 36(14): 3195−3198. DOI: 10.19829/j.zgfybj.issn.1001-4411.2021.14.009. (in Chinese).
    [14] 晏乘曦, 唐光才, 程晓光. 肌少症的定量测量现状及研究进展[J]. 中国骨质疏松杂志, 2018,24(6): 814−819. doi: 10.3969/j.issn.1006-7108.2018.06.021

    YAN C X, TANG G C, CHENG X G. State of the art of quantitative me asurement of sarcopenia[J]. Chinese Journal of Osteoporosis, 2018, 24(6): 814−819. (in Chinese). doi: 10.3969/j.issn.1006-7108.2018.06.021
    [15] 耿楠, 孔明, 陈煜, 等. 第三腰椎骨骼肌指数在终末期肝病营养诊断中的应用价值[J]. 临床肝胆病杂志, 2021,37(10): 2493−2496. doi: 10.3969/j.issn.1001-5256.2021.10.050

    GENG N, KONG M, CHENG Y, et al. Value of L3 skeletal muscle index in nutritional diagnosis of end-stage liver disease[J]. Journal of Clinical Hepatology, 2021, 37(10): 2493−2496. (in Chinese). doi: 10.3969/j.issn.1001-5256.2021.10.050
    [16] FAHAL I H. Uraemic sareopenia: Aetiology and implications[J]. Nephml Dial Transplant, 2014, 29(9): 1655−1665. doi: 10.1093/ndt/gft070
    [17] PRADO C M, LIEFFERS J R, MCCARGAR L J, et al. Prevalence andclinical implications of sarcopenic obesity in patients with solidtumours of the respiratory and gastrointestinal tracts: Apopulation-based study[J]. Lancet Oncology, 2008, 9(7): 629. doi: 10.1016/S1470-2045(08)70153-0
  • 加载中
图(4) / 表(4)
计量
  • 文章访问数:  76
  • HTML全文浏览量:  15
  • PDF下载量:  6
  • 被引次数: 0
出版历程
  • 收稿日期:  2022-03-22
  • 录用日期:  2022-06-25
  • 网络出版日期:  2022-06-30

目录

    /

    返回文章
    返回