维持性血液透析患者钙磷代谢及甲状旁腺素水平横断面调查

刘丽茹; 何敏华

doi:10.3969/j.issn.1671-2390.2018.01.006

维持性血液透析患者钙磷代谢及甲状旁腺素水平横断面调查

Cross-sectional survey of the association of calcium and phosphorus metabolism with parathyroid hormone levels in maintained hemodialysis patients

摘要

摘要: 目的根据透析病人生存质量指南标准调查大理大学第一附属医院维持性血液透析（MHD）患者钙磷代谢及甲状旁腺素的达标率，评价其危险因素，为临床治疗提供依据。方法对我院128例MHD患者的血钙、血磷、血清白蛋白、血清碱性磷酸酶、甲状旁腺素（iPTH）等进行检验，并根据透析病人生存质量指南标准进行达标率统计；对患者年龄（≤ 45岁组和>45岁组）、残余尿量（尿量<100 ml/d的无尿组和尿量≥ 100 ml/d的有尿组）、透析时间（<3年组和≥ 3年组）、透析充分性（eKt/V ≥ 1.2和eKt/V<1.2）分别分组，并对组间血钙、血磷、钙磷乘积、ALP、iPTH、URR%、eKt/V等指标进行比较；采用多元逐步回归分析iPTH与年龄、透析时间、血钙、血磷、钙磷乘积、血清白蛋白、碱性磷酸酶、尿素氮、血肌酐、残余尿量等的关系。结果 128例患者中血钙、血磷、钙磷乘积、iPTH达标率分别为48.4%、42.2%、58.6%、25%，四项指标均达标的患者12例，占9.38%。≤ 45岁组和>45岁组组间血磷、钙磷乘积、无尿组和有尿组组间iPTH，透析充分组和透析不充分组组间URR%差异有统计学意义（P<0.05）。iPTH与透析时间、血钙呈负相关，与血磷、碱性磷酸酶、血肌酐呈正相关。结论本院MHD患者钙磷代谢及甲状旁腺素水平达标率较低，临床上需加强患者宣教，在合理使用磷结合剂、充分透析同时，注意监测总结治疗效果及不良反应，以改善MHD患者的预后。

Abstract: Objective To investigate the control rate of calcium-phosphorus metabolism and parathyroid hormone in maintained hemodialysis patients in the First Affiliated Hospital of Dali University according to K/DOQI guidelines. Relating risk factors will be further explored to provide evidence for treatment.Methods Serum calcium and phosphorus, albumin, alkaline phosphatase (ALP), parathyroid hormone (iPTH) levels were detected in 128 maintained hemodialysis patients, and the control rate of those makers was analyzed according to the K/DOQI guidelines. Patients were grouped by the age (≤ 45 and >45 age group), residual urine volume (anuria groups:urine volume <100 ml/d and urinary groups:urine volume ≥ 100 ml/d), dialysis age (<3 years and ≥ 3 years group), dialysis adequacy (eKt/V ≥ 1.2 and eKt/V<1.2), and compared the difference of serum calcium, phosphorus and calcium phosphorus product, ALP, iPTH, URR%, eKt/V index between groups. Stepwise multivariable regression analysis was used to investigate the relationship of iPTH with age, dialysis age, serum calcium, serum phosphorus, calcium phosphorus product, albumin, ALP, serum urea nitrogen and creatinine as well as residual urine volume.Results The control rate of serum calcium, phosphorus, calcium-phosphorus product, iPTH were 48.4%, 42.2%, 58.6% and 25%, respectively. All the four makers were under control in 12 patients (9.38%). There was significant difference in serum phosphorus and calcium-phosphorus product between patients ≤ 45 years and those >45 years patients (P<0.05). The difference of iPTH levels between anuria patients and urinary patients was significant (P<0.05). There was also significant difference in URR% between adequate dialysis patients and inadequate dialysis patients (P<0.05). iPTH was negatively correlated to the duration of dialysis and serum calcium, and positively correlated with serum phosphorus, alkaline phosphatase and creatinine.Conclusions The control rates of calcium-phosphorus metabolism and parathyroid hormone in maintained hemodialysis patients in our hospital were lower. Serum phosphorus levels were difficult to control in younger patients, and the protection of residual urine might be helpful to control iPTH.

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