低钠血症与骨折、骨质疏松的相关性研究
发布时间：2018-11-05 06:57
【摘要】：目的临床诊疗中最多见的电解质内环境紊乱是低钠血症,急性、重度的低钠血症可能会引起脑水肿,或者治疗时发生神经脱髓鞘病变等严重并发症而受到临床广泛重视,但是轻度、持续的低钠血症因其缺乏明确的相关症状或危害一直未被正确理解、缺乏重视。然而近来相关的研究指出低钠血症可能会影响患者的神经系统功能,影响步态,易发生跌倒,进而导致骨折。同时低钠内环境或许会改变骨代谢调节,发生骨质疏松。但是现有的研究主要以四肢创伤性骨折为研究对象,而且对于贫血、低蛋白血证等潜在的干扰因素未予以考虑。本研究以脊柱外科患者为研究对象,同时纳入与骨折、骨质疏松相关的多项潜在干扰混杂因素,进一步探讨低钠血症与骨折、骨质疏松的相关性。方法本研究为横断面调查研究,研究对象是2015年6月至2016年7月期间收住于西安市红会医院脊柱外科以脊柱创伤和退变性疾病为主要诊断的患者,通过病历查阅收集汇总患者的基本信息,包括患者的性别、年龄、身高、体重、BMI、绝经情况、合并心脑血管、内分泌代谢系统疾病情况以及贫血、低蛋白血症患病情况等其他可能的潜在干扰因素,以及患者的诊断、创伤患者致病因素、腰椎、髋部的骨密度等资料,严格纳入与排除标准,通过统计学差异性推断与相关性分析,探索、评价低钠血症与骨折、骨质疏松的相关性。结果统计分析结果示,与血钠正常组患者相比,低钠血症组患者骨折发生率高,腰椎、股骨颈以及全髋部骨密度、T值均比血钠正常组低,差异均具有统计学意义(p0.05)。进一步多因素回归分析,校正其他潜在的干扰因素后,低钠血症仍然是骨折的一项独立危险因素(OR=2.618,95%CI[1.831-3.743],p0.001),同时,也是骨质疏松的一项独立危险因素(OR=2.380,95%CI[1.646-3.441],p0.001)。在骨折的病因分组间进一步分析发现,相比于交通意外伤,暴力挤压伤组,自行跌倒组患者其血钠浓度偏低,与其他各组间的差异存在统计学意义(p0.05)。对于骨密度和血钠水平做了进一步的相关性探索,结果示,腰椎部、股骨颈部及全髋部骨密度T值与血钠浓度之间均存在一定的线性相关性,即剂量效应关系(p0.001)。结论本研究通过横断面研究设计,经过统计学推断及相关性研究得出,低钠血症是骨质疏松的一项独立的危险因素,同时也是跌落伤所致骨折的一项独立危险因素。腰椎部、股骨颈部及全髋部骨密度T值与血钠浓度存在一定的线性相关性。血钠浓度或许可以作为一项骨折及骨质疏松的危险性预测因素,对骨折的预防,骨质疏松的早期诊治提供新的方向与思路。
[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.
【学位授予单位】：西安医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R580;R683
本文编号：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.
【学位授予单位】：西安医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R580;R683
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相关期刊论文 前3条
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