低鈉血癥與骨折、骨質(zhì)疏松的相關(guān)性研究
發(fā)布時間：2018-11-05 06:57
【摘要】：目的臨床診療中最多見的電解質(zhì)內(nèi)環(huán)境紊亂是低鈉血癥,急性、重度的低鈉血癥可能會引起腦水腫,或者治療時發(fā)生神經(jīng)脫髓鞘病變等嚴重并發(fā)癥而受到臨床廣泛重視,但是輕度、持續(xù)的低鈉血癥因其缺乏明確的相關(guān)癥狀或危害一直未被正確理解、缺乏重視。然而近來相關(guān)的研究指出低鈉血癥可能會影響患者的神經(jīng)系統(tǒng)功能,影響步態(tài),易發(fā)生跌倒,進而導(dǎo)致骨折。同時低鈉內(nèi)環(huán)境或許會改變骨代謝調(diào)節(jié),發(fā)生骨質(zhì)疏松。但是現(xiàn)有的研究主要以四肢創(chuàng)傷性骨折為研究對象,而且對于貧血、低蛋白血證等潛在的干擾因素未予以考慮。本研究以脊柱外科患者為研究對象,同時納入與骨折、骨質(zhì)疏松相關(guān)的多項潛在干擾混雜因素,進一步探討低鈉血癥與骨折、骨質(zhì)疏松的相關(guān)性。方法本研究為橫斷面調(diào)查研究,研究對象是2015年6月至2016年7月期間收住于西安市紅會醫(yī)院脊柱外科以脊柱創(chuàng)傷和退變性疾病為主要診斷的患者,通過病歷查閱收集匯總患者的基本信息,包括患者的性別、年齡、身高、體重、BMI、絕經(jīng)情況、合并心腦血管、內(nèi)分泌代謝系統(tǒng)疾病情況以及貧血、低蛋白血癥患病情況等其他可能的潛在干擾因素,以及患者的診斷、創(chuàng)傷患者致病因素、腰椎、髖部的骨密度等資料,嚴格納入與排除標(biāo)準,通過統(tǒng)計學(xué)差異性推斷與相關(guān)性分析,探索、評價低鈉血癥與骨折、骨質(zhì)疏松的相關(guān)性。結(jié)果統(tǒng)計分析結(jié)果示,與血鈉正常組患者相比,低鈉血癥組患者骨折發(fā)生率高,腰椎、股骨頸以及全髖部骨密度、T值均比血鈉正常組低,差異均具有統(tǒng)計學(xué)意義(p0.05)。進一步多因素回歸分析,校正其他潛在的干擾因素后,低鈉血癥仍然是骨折的一項獨立危險因素(OR=2.618,95%CI[1.831-3.743],p0.001),同時,也是骨質(zhì)疏松的一項獨立危險因素(OR=2.380,95%CI[1.646-3.441],p0.001)。在骨折的病因分組間進一步分析發(fā)現(xiàn),相比于交通意外傷,暴力擠壓傷組,自行跌倒組患者其血鈉濃度偏低,與其他各組間的差異存在統(tǒng)計學(xué)意義(p0.05)。對于骨密度和血鈉水平做了進一步的相關(guān)性探索,結(jié)果示,腰椎部、股骨頸部及全髖部骨密度T值與血鈉濃度之間均存在一定的線性相關(guān)性,即劑量效應(yīng)關(guān)系(p0.001)。結(jié)論本研究通過橫斷面研究設(shè)計,經(jīng)過統(tǒng)計學(xué)推斷及相關(guān)性研究得出,低鈉血癥是骨質(zhì)疏松的一項獨立的危險因素,同時也是跌落傷所致骨折的一項獨立危險因素。腰椎部、股骨頸部及全髖部骨密度T值與血鈉濃度存在一定的線性相關(guān)性。血鈉濃度或許可以作為一項骨折及骨質(zhì)疏松的危險性預(yù)測因素,對骨折的預(yù)防,骨質(zhì)疏松的早期診治提供新的方向與思路。
[Abstract]:Objective hyponatremia is the most common environmental disorder in electrolytes in clinical diagnosis and treatment. Acute and severe hyponatremia may cause brain edema, or serious complications such as neurodemyelination, etc. However, mild, persistent hyponatremia has been poorly understood and neglected due to its lack of clear associated symptoms or hazards. However, recent studies have shown that hyponatremia may affect nervous system function, gait, fall and fracture. At the same time, the internal environment of low sodium may change the regulation of bone metabolism, resulting in osteoporosis. However, the existing studies mainly focus on traumatic fracture of limbs, and the potential interference factors, such as anemia, low protein blood syndrome, are not taken into account. In this study, spinal surgery patients were included in the study, and a number of potential interference confounding factors related to fracture and osteoporosis were included to further explore the correlation between hyponatremia and fracture and osteoporosis. Methods this study was a cross-sectional study. The subjects of the study were patients who were mainly diagnosed with spinal trauma and degenerative diseases in the spinal surgery department of Xi'an Honghui Hospital from June 2015 to July 2016. The patient's basic information was collected through medical records, including gender, age, height, weight, BMI, menopause, cardiovascular and cerebrovascular diseases, endocrine and metabolic diseases, and anemia. Other potential interference factors, such as hypoproteinemia, as well as the diagnosis of patients, the risk factors of trauma patients, bone mineral density of lumbar vertebrae and hip, are strictly included and excluded. To evaluate the correlation between hyponatremia and fracture and osteoporosis by statistical difference inference and correlation analysis. Results the results of statistical analysis showed that the incidence of fracture in hyponatremia group was higher than that in normal group. The bone mineral density (BMD) of lumbar vertebra, femoral neck and total hip were lower in hyponatremia group than those in normal group (p0.05). After further multivariate regression analysis, adjusted for other potential interference factors, hyponatremia remained an independent risk factor for fractures (OR=2.618,95%CI [1.831-3.743], p 0.001), while, It is also an independent risk factor for osteoporosis (OR=2.380,95%CI [1.646-3.441], p 0.001). Further analysis among the etiological groups of fracture found that compared with traffic accident group, the serum sodium concentration of patients with spontaneous fall group was lower than that of traffic accident group, and the difference was statistically significant compared with other groups (p0.05). The correlation between bone mineral density (BMD) and serum sodium level was further explored. The results showed that there was a linear correlation between BMD T value and serum sodium concentration in lumbar vertebrae, femoral neck and total hip, that is, dose-effect relationship (p0.001). Conclusion according to the cross-sectional study design, it is concluded that hyponatremia is an independent risk factor for osteoporosis and an independent risk factor for fracture caused by falling injury. There was a linear correlation between bone mineral density T value and serum sodium concentration in lumbar vertebrae, femoral neck and total hip. The serum sodium concentration may be a predictor of the risk of fracture and osteoporosis, and provide a new direction and thought for the prevention of fracture and early diagnosis and treatment of osteoporosis.
【學(xué)位授予單位】：西安醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R580;R683
本文編號：2311270
[Abstract]:Objective hyponatremia is the most common environmental disorder in electrolytes in clinical diagnosis and treatment. Acute and severe hyponatremia may cause brain edema, or serious complications such as neurodemyelination, etc. However, mild, persistent hyponatremia has been poorly understood and neglected due to its lack of clear associated symptoms or hazards. However, recent studies have shown that hyponatremia may affect nervous system function, gait, fall and fracture. At the same time, the internal environment of low sodium may change the regulation of bone metabolism, resulting in osteoporosis. However, the existing studies mainly focus on traumatic fracture of limbs, and the potential interference factors, such as anemia, low protein blood syndrome, are not taken into account. In this study, spinal surgery patients were included in the study, and a number of potential interference confounding factors related to fracture and osteoporosis were included to further explore the correlation between hyponatremia and fracture and osteoporosis. Methods this study was a cross-sectional study. The subjects of the study were patients who were mainly diagnosed with spinal trauma and degenerative diseases in the spinal surgery department of Xi'an Honghui Hospital from June 2015 to July 2016. The patient's basic information was collected through medical records, including gender, age, height, weight, BMI, menopause, cardiovascular and cerebrovascular diseases, endocrine and metabolic diseases, and anemia. Other potential interference factors, such as hypoproteinemia, as well as the diagnosis of patients, the risk factors of trauma patients, bone mineral density of lumbar vertebrae and hip, are strictly included and excluded. To evaluate the correlation between hyponatremia and fracture and osteoporosis by statistical difference inference and correlation analysis. Results the results of statistical analysis showed that the incidence of fracture in hyponatremia group was higher than that in normal group. The bone mineral density (BMD) of lumbar vertebra, femoral neck and total hip were lower in hyponatremia group than those in normal group (p0.05). After further multivariate regression analysis, adjusted for other potential interference factors, hyponatremia remained an independent risk factor for fractures (OR=2.618,95%CI [1.831-3.743], p 0.001), while, It is also an independent risk factor for osteoporosis (OR=2.380,95%CI [1.646-3.441], p 0.001). Further analysis among the etiological groups of fracture found that compared with traffic accident group, the serum sodium concentration of patients with spontaneous fall group was lower than that of traffic accident group, and the difference was statistically significant compared with other groups (p0.05). The correlation between bone mineral density (BMD) and serum sodium level was further explored. The results showed that there was a linear correlation between BMD T value and serum sodium concentration in lumbar vertebrae, femoral neck and total hip, that is, dose-effect relationship (p0.001). Conclusion according to the cross-sectional study design, it is concluded that hyponatremia is an independent risk factor for osteoporosis and an independent risk factor for fracture caused by falling injury. There was a linear correlation between bone mineral density T value and serum sodium concentration in lumbar vertebrae, femoral neck and total hip. The serum sodium concentration may be a predictor of the risk of fracture and osteoporosis, and provide a new direction and thought for the prevention of fracture and early diagnosis and treatment of osteoporosis.
【學(xué)位授予單位】：西安醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R580;R683
【參考文獻】
相關(guān)期刊論文 前3條
1 牛興邦;郝定均;;慢性低鈉血癥與骨折、骨質(zhì)疏松的相關(guān)性[J];中華骨質(zhì)疏松和骨礦鹽疾病雜志;2016年04期
2 牛興邦;郝定均;;低鈉血癥與骨質(zhì)疏松相關(guān)性的研究進展[J];中國骨質(zhì)疏松雜志;2016年04期
3 韓亞軍;帖小佳;伊力哈木·托合提;;中國中老年人骨質(zhì)疏松癥患病率的Meta分析[J];中國組織工程研究;2014年07期
，本文編號：2311270
本文鏈接：http://www.sikaile.net/yixuelunwen/nfm/2311270.html
最近更新
教材專著
