360例慢性肾脏病矿物质-骨代谢异常发病率及治疗状况调查  

Survey of the morbidity in mineral and bone metabolism disturbance and treatment condition in patients with Chronic Kidney Disease

作　　者：吴军[1] 王艺[1] 杨莉[1] 朱学雷[1] 谢明媚[1] 吴小冬[1] 王天义[1] 

机构地区：[1]安徽省安庆市第一人民医院肾内科,246000

出　　处：《中国老年保健医学》2011年第5期20-21,共2页Chinese Journal of Geriatric Care

摘　　要：目的通过调查慢性肾脏病(CKD)3～5期患者的钙、磷代谢情况及甲状旁腺激素(PTH)水平,分析该类患者继发性甲状旁腺功能亢进症(SPHT)发生及治疗情况。方法回顾性分析于2008年11月至2009年11月在我院肾病科就诊的268例CKD3～5期患者血钙、血磷、钙磷乘积、PTH水平及治疗情况等。结果①73.88%的CKD3～5期患者存在着不同程度的SPHT。②CKD患者的PTH水平与血磷、钙磷乘积呈线性正相关(P<0.001),与矫正钙呈负相关(P<0.001)。③治疗状况:依据NKF-K/DOQI建议,应使用活性维生素D治疗的有119例,其中49.58%服用了骨化三醇,未治疗比例达50.42%。HP+HD能比HD更有效清除PTH。结论 CKD3～5期患者普遍存在SPHT;HP+HD能比HD更有效清除PTH;医生对CKD患者矿物质-骨代谢异常缺乏足够重视。Objective To investigate the incidence of secondary hyperparathyroidism in patients with 3 ～5 stage of Chronic Kidney Disease（CKD） and their treatment by detecting metabolism of calcium and phosphorus and the PTH level. Methods By analyzing retrospectively the clinical date of 268 patients with 3 ～ 5 stage of CKD who was admitted into our hospital from November 2008 to November 2009,serum calcium,phosphorus,calcium-phosphorus product,PTH and corresponding managemant. Results ①73. 88 % patients with 3 ～ 5 stage of CKD had secondary hyperparathyroidism of different severity. ②The levels of PTH is positive correlation with those of serum phosphorus、calcium-phosphorus product（P 0. 001） and negative correlation with adjusted serum calcium （P 0. 001） . ③According to K/DOQI guideline,119 patients should receive active vitamin D therapy and 49. 58% patients used calcitriol,and the proportion of patients who potentially underused was to 50. 42% . HP ＋ HD can remove PTH more effective than HD. Conclusion Disturbances in mineral and bone metabolsm caused secondary hyperparathyroidism are prevalent in 3 ～ 5 stage of CKD. HP ＋ HD can remove PTH more effective than HD. Clinician couldn’t think highly of their diagnosis and management.

关 键 词：慢性肾脏病 继发性甲状旁腺功能亢进症(SHPT) 甲状旁腺激素(PTH) 血钙 血磷 

分 类 号：R692[医药卫生—泌尿科学]