血液透析患者钙磷代谢紊乱和甲状旁腺功能异常的研究  

Investigation on the disorders in calcium and phosphorus metabofism and abnormity in parathyroidfunction in the patients with maintenance hemodiaiysis

作　　者：易扬[1] 路建饶[1] 顾波[1] 王汉清[1] 董蓓晔[1] 宣怡[1] 赵颖丹[1] 郭志勇[2] 

机构地区：[1]上海市静安区中心医院复旦大学附属华山医院静安分院肾内科,200040现在上海市第七人民医院肾内科 [2]第二军医大学附属长海医院肾内科

出　　处：《中国综合临床》2011年第11期1123-1126,共4页Clinical Medicine of China

基　　金：上海市卫生局科研课题计划项目（2010109）

摘　　要：目的探讨血液透析患者钙磷代谢紊乱和甲状旁腺功能异常的情况及其可能的影响因素。方法选择2009年1月至2010年12月在上海市静安区中心医院血液透析中心行常规血液透析3个月以上病情稳定的慢性尿毒症患者198例，所有患者于透析前空腹抽血，检测血红蛋白、血清肌酐、尿素氮、钙、磷、全段甲状旁腺激素（iPTH）、超敏c．反应蛋白（hs-CRP）、白蛋白（Alb）等，同时测定透析后血清尿素氮浓度，记录超滤量、透析后体重和透析时间，根据公式计算血清白蛋白校正钙（Ac-Ca）和尿素清除指数（Kt／V）。参照美国肾脏病基金会慢性透析患者骨代谢和疾病临床实践指南的要求，统计钙磷代谢和甲状旁腺功能水平的达标情况，根据患者血清iPTH浓度分为达标组（150-300ng／L）、低于达标组（〈150ng／L）和高于达标组（〉300ng／L），分析其可能的影响因素。结果198例血液透析患者校正的血钙达标110例（55．6％），血磷达标118例（59．6％），钙磷乘积达标143例（72．3％），血iPTH达标39例（19．7％），四项均达标28例（14．1％）。然而，血iPTH平均浓度为（133．65±126．37）ng／L，低于标准132例（66．7％），高于标准27例（13．6％）。随着血液透析患者年龄的增长，其iPTH平均浓度逐渐下降（r=-0．258，P〈0．01）。3组比较，低于达标组患者的年龄最大，平均血hs-CRP最高，平均血磷和Alb浓度最低，差异均有统计学意义（P均〈0．05）。3组的性别构成、透析时间、糖尿病的发生率、血压、血红蛋白、尿素氮、肌酐、校正钙和Kt／V等指标差异无统计学意义。结论维持性血液透析患者普遍存在钙磷代谢和甲状旁腺功能紊乱的问题，应重视甲状旁腺功能低下的现象，其发生可能与老年、营养不良、潜在感染等因素有关，有待进一步研究。Objective To investigate disorders in calcium and phosphorus metabolism and abnonnity in parathyroid function and their related factors in maintenance hemodialysis （MHD） patients. Methods We collected serum Hb, SCr, BUN, calcium, phosphorus, iPTH, high sensitivity C-reactive protein （ hs-CRP）, albumin and calculated albumin-corrected Ca and Kt/V from 198 patients with MHD in Jing＇an District Central Hospital,Shanghai from Jan. 2009 to Dec. 2010. The calcium and phosphorus metabolism and parathyroid function were evaluated according to the guidelines of bone metabolism and controlling of bone disease in Kidney Disease Outcome Quality Initiative （KDOQI） recommended by National Kidney Foundation of the United States. 198 patients were classified into the standard group （ 150 - 300 ng/L）, lower than the standard group （ 〈 150 ng/L） and higher than the standard group（ 〉 300 ng/L） according to serum iPTH levels. Results In the 198 cases,ll0 cases were normal in serum Ac-Ca（55.6%）; 118 cases were normal in serum phosphorus （59. 6% ）; 143 cases were normal in Ca x P （72.3%）; 39 cases were normal in iPTH （19.7%）. All four items up to the standard were 28 cases （ 14. 1% ） among 198 cases. However, 132 （66.7%） patients showed lower than 150 ng/L in serum iPTH. The average serum iPTH gradually decreased with age. The senior patients demonstrated the highest average serum Hs-CRP, the lowest average serum phosphorus and the lowest albumin. There were no statistical significance in sex, hemodialysis duration, diabetes, blood pressure, Hb, Bun,SCr,Ac-Ca and Kt/V among three groups. Conclusion The disorders in Calcium and phosphorus metabolism and abnormity in parathyroid function is common in the MHD patients. We should pay attention to hypofunction of parathyroid gland in the patients with MHD, which may be related to aging, malnutrition and potential infection. These findings need further investigation.

关 键 词：血液透析 慢性肾功能衰竭 钙磷代谢 甲状旁腺激素 

分 类 号：R692.5[医药卫生—泌尿科学]