安徽省维持性血液透析患者血清磷水平及其影响因素分析

钮铮; 石瑞; 汪炜; 李秀勇; 白友为; 刘智; 梁绍钦; 陈雷; 王德光

doi:10.3969/j.issn.1671-2390.2024.06.002

安徽省维持性血液透析患者血清磷水平及其影响因素分析

Analysis of serum phosphorus level and its influencing factors in maintenance hemodialysis patients in Anhui province

摘要

摘要:
目的分析维持性血液透析（maintenance hemodialysis，MHD）患者血清磷水平现状及其与临床指标的关系，探讨血清磷水平的相关影响因素。
方法本研究为多中心横断面研究。纳入2019～2020年安徽医科大学第二附属医院血液净化中心等27家透析中心2667例MHD患者，收集相关人口学特征、原发病、实验室检查等资料。按照血清磷水平分为低血磷组（磷<1.13 mmol/L），正常血磷组（1.13≤磷≤1.78 mmol/L）和高血磷组（磷＞1.78 mmol/L）。单因素方差分析3组间临床指标的差异，多元线性回归分析血清磷水平的相关影响因素。
结果 MHD患者中，低血磷组、正常血磷组、高血磷组分别占比7.6%、35.3%和57.1%。Spearman相关分析发现，年龄（r = −0.167，P<0.001）与血磷水平呈负相关，体重（r = 0.09，P<0.001）、体重指数（r = 0.088，P<0.001）、血红蛋白（r = 0.099，P<0.001）、尿素氮（r = 0.4，P<0.001）、肌酐（r = 0.357，P<0.001）、血镁（r = 0.253，P<0.001）、血清白蛋白（r = 0.117，P<0.001）、尿酸（r = 0.253，P<0.001）、甲状旁腺激素（r = 0.299，P<0.001）、总胆固醇（r = 0.1，P<0.001）、三酰甘油（r = 0.09，P<0.001）、低密度脂蛋白胆固醇（r = 0.043，P = 0.027）、老年营养风险指数（r = 0.162，P<0.001）呈正相关；多元线性回归发现，MHD患者血磷水平与体重指数（β = 0.163，P<0.001）、血红蛋白（β = 0.06，P = 0.001）、尿素氮（β = 0.238，P<0.001）、肌酐（β = 0.152，P<0.001）、血镁（β = 0.117，P<0.001）、甲状旁腺激素（β = 0.196，P<0.001）独立相关。
结论 MHD患者高磷水平占比较高，血红蛋白、尿素氮、肌酐、血钙、血镁、甲状旁腺激素是影响MHD患者血磷水平下降的独立因素。

Abstract:
Objective To explore the current status of serum phosphorus level in patients on maintenance hemodialysis （MHD）, examine its relationship with clinical parameters and determine the influencing factors of serum phosphorus level.
Methods For this multicenter cross-sectional study, 2667 patients on MHD at 27 domestic dialysis centers were recruited from 2019 to 2020. Demographic profiles, primary diseases and laboratory tests were recorded. According to serum phosphorus （P） level, they were assigned into three groups of low blood phosphorus （P<1.13 mmol/L）, normal blood phosphorus （1.13≤P≤1.78 mmol/L） and high blood phosphorus （P<1.78 mmol/L）. One-way analysis of variance （ANOVA） was performed for examining the differences in clinical parameters among three groups. Multiple linear regression was performed for examining the influencing factors associated with serum phosphorus level.
Results Low/normal/high blood phosphorus groups accounted for 7.6%, 35.3% and 57.1% respectively. Spearman's correlation analysis revealed that age （r = −0.167, P<0.001） was correlated negatively with blood phosphorus level. Body weight （r = 0.09, P<0.001）, body mass index （BMI）（r = 0.088, P<0.001）, hemoglobin （r = 0.099, P<0.001）, blood urea nitrogen （BUN）（r = 0.4, P<0.001）, creatinine （r = 0.357, P<0.001）, blood magnesium （r = 0.253, P<0.001）, serum albumin （r = 0.117, P<0.001）, uric acid （r = 0.253, P<0.001）, parathyroid hormone （r = 0.299, P<0.001）, total cholesterol （r = 0.1, P<0.001）, triglyceride （r = 0.09, P<0.001）, low-density lipoprotein cholesterol （r = 0.043, P = 0.027） and elderly nutritional risk index （r = 0.162, P<0.001） were positively correlated. Multiple linear regression revealed that blood phosphorus level was correlated independently with BMI （β = 0.163, P<0.001）, hemoglobin （β = 0.06, P = 0.001）, BUN （β = 0.238, P<0.001）, creatinine （β = 0.152, P<0.001）, blood magnesium （β = 0.117, P<0.001） and parathyroid hormone （β = 0.196, P<0.001）.
Conclusion High phosphorus level appears a high proportion of MHD patients. Hemoglobin, BUN, creatinine, blood calcium, blood magnesium and parathyroid hormone are independent influencing factors for lower level of blood phosphorus in MHD patients.

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