全段甲状旁腺激素、胎球蛋白A、血肌酐血红蛋白比与慢性肾脏病维持性血液透析患者钙磷代谢紊乱的关系及对颈动脉钙化的预测价值

王晓辉; 蔡春天; 何娟; 赵肖帆; 贺良平; 李明虎; 李学英

doi:10.3969/j.issn.1671-2390.2022.04.003

全段甲状旁腺激素、胎球蛋白A、血肌酐血红蛋白比与慢性肾脏病维持性血液透析患者钙磷代谢紊乱的关系及对颈动脉钙化的预测价值

Relationship between intact parathyroid hormone,fetal globulin A,serum creatinine/hemoglobin ratio and disorder of calcium and phosphorus metabolism in maintenance hemodialysis patients with chronic kidney disease and their predictive values for carotid artery calcification

摘要

摘要: 目的探讨全段甲状旁腺素(intact parathyroid hormone,iPTH)、胎球蛋白A(fetuin-A,FA)、血肌酐血红蛋白比(serum creatinine/hemoglobin,Scr/Hb)与慢性肾脏病(chronic kidney disease,CKD)维持性血液透析(maintenance hemodialysis,MHD)患者钙磷代谢紊乱的关系,并分析各指标对颈动脉硬化的预测价值。方法选取2014年7月至2020年7月重庆医科大学附属九龙坡中医院收治的113例行MHD治疗的CKD患者,根据是否有颈动脉硬化分为硬化组(n=30)、无硬化组(n=83),比较两组基线资料、iPTH、FA、Scr/Hb,分析颈动脉硬化的相关影响因素,并比较不同iPTH、FA、Scr/Hb表达水平患者钙磷代谢指标,分析iPTH、FA、Scr/Hb与钙磷代谢的相关性及各指标预测颈动脉硬化的价值。结果硬化组患者基线磷、iPTH、Scr/Hb高于无硬化组(1.89±0.42)mmol/L、305.26(152.63,608.19)μg/L、7.16±2.19比(1.30±0.36)mmol/L、238.47(118.05,506.11)μg/L、4.38±1.38,P<0.001,FA低于无硬化组(74.62±20.61)mg/L比(95.33±25.80)mg/L,P<0.05;以113例CKD MHD患者iPTH、FA、Scr/Hb平均值为分界,<平均值为低水平, ≥ 平均值为高水平,iPTH、Scr/Hb高水平者血磷高于低水平者(1.60±0.39)mmol/L比(1.18±0.33)mmol/L,(1.71±0.55)mmol/L比(0.97±0.31)mmol/L,FA高水平者血磷低于低水平者(1.25±0.34)mmol/L比(1.72±0.40)mmol/L,P<0.05;CKD MHD患者iPTH、Scr/Hb与磷呈正相关关系,FA与磷呈负相关关系(P<0.05);iPTH、FA、Scr/Hb仍与CKD MHD患者IMT显著相关(P<0.05);iPTH、FA、Scr/Hb预测颈动脉硬化的曲线下面积(area under the curve,AUC)分别为0.742、0.776、0.790,各指标联合预测的AUC最大,为0.918,最佳预测敏感度、特异度分别为93.33%、85.54%。结论 iPTH、FA、Scr/Hb与CKD MHD患者钙磷代谢紊乱密切相关,且在预测颈动脉硬化方面具有较高应用价值。

Abstract: Objective To explore the relationship between intact parathyroid hormone(iPTH),fetal globulin A(FA),serum creatinine/hemoglobin ratio(Scr/Hb)and calcium and phosphorus metabolism disorder in chronic renal failure patients with chronic kidney disease(CKD)on maintenance hemodialysis(MHD)and examine the predictive value of each parameter for carotid atherosclerosis.Methods From July 2014 to July 2020,113 CKD patients on MHD were recruited and divided into two groups of sclerosis(n=30)and non-sclerosis(n=83). The baseline levels of iPTH,FA and Scr/Hb of two groups were recorded. The related influencing factors of carotid atherosclerosis,parameters of calcium and phosphorus metabolism and their correlations were examined.Results Baseline phosphorus,iPTH and Scr/Hb in sclerosis group were higher than those in non-sclerosis group(1.89±0.42)mmol/L、305.26(152.63,608.19)μg/L、7.16±2.19 vs(1.30±0.36)mmol/L、238.47(118.05,506.11)μg/L、4.38±1.38,P<0.001,FA was lower than that of non-sclerosis group(74.62±20.61)mg/L vs(95.33±25.80)mg/L,P<0.05;mean values of iPTH,FA and Scr/Hb were selected as boundary,<mean value was low level, ≥ mean value high level. High levels of iPTH and Scr/Hb were higher than those with low levels(1.60±0.39)mmol/L vs(1.18±0.33)mmol/L,(1.71±0.55)mmol/L vs(0.97±0.31)mmol/Land those with high levels of FA lower than those with low levels(1.25±0.34)mmol/L vs(1.72±0.40)mmol/L,P<0.05;iPTH,Scr/Hb and phosphorus were positively correlated while FA was negatively correlated with phosphorus(P<0.05);iPTH,FA,Scr/Hb were still associated with IMT(P<0.05);the area under the curve(AUC)of iPTH,FA and Scr/Hb for predicting carotid atherosclerosis were 0.742,0.776 and 0.790respectively. It was the largest at 0.918 for combined predicting. The optimal predictive sensitivity and specificity were 93.33% and 85.54% respectively.Conclusion iPTH,FA and Scr/Hb are closely correlated with disorder of calcium and phosphorus metabolism in chronic renal failure patients with CKD on MHD. These parameters offer high application values in predicting carotid atherosclerosis.

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