Quantitative CT Analysis of Body Composition in Maintenance Hemodialysis Patients
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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），而在健康对照组中，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）cm<sup<2</sup<、（80.65±59.67）cm<sup<2</sup<，均低于健康对照组（135.90±58.80）cm<sup<2</sup<、（122.26±54.94）cm<sup<2</sup<，透析组L3-SMA＜对照组 L3-SMA，（107.00±30.70）cm<sup<2</sup<＜（121.37±32.87）cm<sup<2</sup<，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/cm<sup<3</sup<），与女性（124.29±50.89）（mg/cm<sup<3</sup<）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。Abstract: This study analyzes body composition information in patients on maintenance hemodialysis and explores the application value of QCT technology. Methods: A total of 62 patients on maintenance hemodialysis were selected and divided into three groups according to different dialysis durations. The bone density value, abdominal fat, and muscle content of patients were determined by quantitative CT technology and 62 cases of the health examination population matched by sex and age were selected for comparative analysis. Results: In the dialysis group, osteoporosis accounted for 17.70% (11 cases) and bone loss accounted for 30.60% (19 cases), while in the healthy control group, osteoporosis and bone loss accounted for 6.50% (4 cases) and 16.10% (10 cases), respectively. The difference between these two groups was statistically significant. Moreover, the intra-abdominal and subcutaneous fat content in the dialysis group were (113.70±63.29)cm² and (80.65±59.67)cm², respectively, which were lower than that of the healthy control group ((135.90±58.80)cm² and (122.26±54.94)cm², respectively). Additionally, the dialysis group had a significantly lower L3-SMA (107.00±30.70)cm² than the control group (121.37±32.87)cm², and the lumbar vertebral bone density value was significantly lower in male dialysis patients (156.11±51.94)mg/cm³ than in female dialysis patients (124.29±50.89)mg/cm³. Moreover, the subcutaneous fat content was significantly higher in females than in males; however, the difference in intraperitoneal fat content between males and females was not statistically significant. Additionally, the difference between bone density values and L3-SMA changes in the dialysis group and the length of dialysis time were not statistically significant. Conclusion: The incidence of osteoporosis is higher in patients on maintenance hemodialysis than in healthy people, and the amount of abdominal fat and muscle content are lower than that in healthy people. Moreover, quantitative CT body composition monitoring has high accuracy and sensitivity.
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Keywords:
- quantitative CT /
- hemodialysis /
- bone mineral density /
- abdominal fat
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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
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图 2 测量L1、L2椎体松质骨骨密度值
Figure 2. The measurement of the bone density values of the L1 and L2 vertebral bodies’ cancellous bone
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图 3 示意图，图中勾画的彩色区域即为L3-SMA
Figure 3. Schematic diagram of the L3-SMA (colored outlined area)
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图 4 实测图，绿色光圈内的区域面积相加即得到L3-SMA
Figure 4. In this 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 between the 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％） 
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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 the 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±63.29 135.90±58.80 ＜0.05 皮下脂肪/cm2 80.65±59.67 122.26±54.94 ＜0.05 L3水平横断面肌肉面积/cm2 107.00±30.70 121.37±32.87 ＜0.05
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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±51.94 100.97±58.81 63.47±54.02 女（n=29） 124.29±50.89 128.18±66.07 100.20±60.34 P ＜0.05 ＞0.05 ＜0.05
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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, 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±52.21 134.14±58.36 157.99±47.10 L3水平横断面肌肉面积/cm2 115.91±42.16 103.10±23.65 103.03±24.07
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