摘 要
研究背景：某些研究顯示，尿毒症患者之腎骨病變與其骨骼組織礦物密度的降低有絕對的關係，並且此骨密度降低會增加這類病人發生骨折的機率。對於尿毒症患者，評估其骨質狀況將助於臨床上的預防性治療。目前用於血液透析病人的骨質評估方式有很多種，而定量性超音波骨骼測量乃近來發展出的一項新的且非侵犯性的方法。基於此，我們對於接受血液透析治療的患者設計一前瞻性研究，利用超音波骨密度儀測量其骨質變化，以助於腎骨病變的預防與治療。
研究方法：尿毒症患者（研究組）包含二十三名男性（平均年齡67.52±12.33歲）與十八名女性（平均年齡58.22±11.51歲）。健康受試者（控制組）包含十五名男性（平均年齡64.20±15.98歲）和十五名女性（平均年齡55.60±11.04歲）。研究中所使用的測量工具為定量性超音波骨密度儀，AOS-100（ALOKA公司，日本），利用聲波傳導測量受試者的後腳跟骨部位而得到超音波參數。有三種超音波參數用來做骨質的評估：聲速(speed of sound, SOS)，傳遞指數(transmission index, TI)和骨質超音波評估指數(osteo sono-assessment index, OSI)。研究進行一年的時間，期間每三個月做一次超音波量測與生化檢查。
研究結果：與正常健康受試者比較起來，在尿毒症患者中測得之OSI值呈現有意義的降低（93年11月：p值為0.011；94年2月：p值小於0.001；94年5月：p值小於0.001；94年8月：p值為0.0014；94年11月：p值為0.003）。研究者和控制組之間的Z值並沒有明顯差異性存在。在尿毒症患者中，血清總鈣值與OSI值呈現一微弱卻具統計意義的正相關（r值為0.17，p值為0.014）。副甲狀腺激素值和Z值之間存在一統計意義的關聯性（r值為-0.11，p值為0.101）。OSI值和透析治療年齡呈現一微弱之負相關，但不具統計上意義（r值為-0.162，p值為0.312）。而Z值和透析治療年齡並無相關性（r值為-0.082，p值為0.612）。
結論：本研究發現，與正常健康控制組比較下，尿毒症患者的OSI測量值呈現有意義地降低。這意指OSI參數值有用於偵測血液透析病人的低骨密度狀況，是一個良好的偵測指標。我們認為超音波骨密度測量可使用於治療腎骨病變中的監測。然而，仍需要有一大型且長時間的研究來更確定此定量性超音波測量在臨床上的應用。

Abstract
Background: Some studies have shown that reduced bone mineral density is associated with renal osteodystrophy in uremic patients and fracture risk is generally increased in these patients. Identifying uremic patients at high risk of fractures can help prevention treatment. Quantitative ultrasound skeletal measurement is recently a new non-invasive method of bone assessment in dialysis patients. Herein we designed a prospective study of ultrasound skeletal measurement in patients on hemodialysis treatment. This study was to determine whether ultrasound skeletal measurement would be useful to monitor intervention in treating patients of renal osteodystrophy.
Methods: The study group included 23 men aged 67.52 ± 12.33 years and 18 women aged 58.22 ± 11.51 years. The control group consisted of 15 men aged 64.20 ± 15.98 and 15 women aged 55.60 ± 11.04 years. Quantitative ultrasound was performed with an acoustic osteo screener, AOS-100 device, which measures parameters through the calcaneus by means of the ultrasound transmission method. There were three values detected: speed of sound (SOS), transmission index (TI) and osteo sono-assessment (OSI). This prospective study was performed for 1 year. We measured the ultrasound parameters in both study groups and biochemical tests in our patients every three months.
Results: OSI values were significantly lower in uremic patients compared with normal healthy population(p＝0.011 in November, 2004; p＜0.001 in February, 2005; p＜0.001 in May, 2005; p＝0.0014 in August, 2005; p＝0.003 in November, 2005). There were no significant differences between Z-scores of the uremic patients and the control population. Serum total calcium level showed a weak, positive, but statistically significant correlation with OSI (r＝0.17, p＝0.014). There was a lower, statistically significant correlation between i-PTH and Z-score (r＝-0.17, p＝0.018). OSI values failed to correlate with i-PTH levels (r＝-0.11, p＝0.101). A weak, inverse but not statitsically significant correlation was found between OSI and duration of dialysis (r＝-0.162, p＝0.312). The correlation between Z-score and duration of dialysis neither show no significant relationship (r＝-0.082, p＝0.612).
Conclusions: The OSI results in the group of uremic patients were significantly lower than in the healthy control group comparable in age, weight and hight. This implies that OSI parameter may be useful and a good indicator in detecting low bone mineral density in patients on hemodialysis. We concluded that ultrasound skeletal measurement would be useful to monitor intervention in treating patients of renal osteodystrophy. However, further investigations in large-scale patient group and a long period of study time are required to determine the clinical usefulness of quantitative ultrasound.

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