维持性血液透析患者采用不同血液净化方式心脏瓣膜钙化高危因素分析  

Risk factors for cardiac valve calcification in maintenance hemodialysis patients with different blood purification techniques

作　　者：周长菊[1] 章旭[1] 曹娟[1] 印荻[1] 李海涛[1] 王国华[1] 许琴 赵彩霞[1] 丁浩[1] 

机构地区：[1]扬州大学附属泰兴医院肾内科,江苏泰兴225400

出　　处：《新乡医学院学报》2012年第4期282-285,共4页Journal of Xinxiang Medical University

基　　金：江苏省卫生厅面上科研课题(编号:H200834)

摘　　要：目的观察维持性血液透析患者采用不同血液净化方式心脏瓣膜钙化患病情况及高危因素分析。方法收集在泰兴市人民医院血液净化中心维持血液透析患者54例,分为血液透析(HD)组18例、血液滤过(HDF)组18例、血液灌流串联血液透析(HP+HD)组18例。观察各组患者治疗前后血钙、血磷、甲状旁腺激素(PTH)指标变化及心脏瓣膜钙化程度,分析血钙、血磷、钙磷乘积、PTH与心脏瓣膜钙化的关系。结果 (1)治疗12个月后54例患者中有23例(42.59%)出现不同程度的心脏瓣膜钙化,3组患者心脏瓣膜钙化发生率分别为HD组55.56%,HDF组44.44%,HP+HD组27.78%,差异有统计学意义(P<0.05)。(2)治疗12个月后,Ⅰ度钙化组血磷、钙磷乘积及PTH水平明显高于无钙化组(P<0.05),Ⅱ、Ⅲ度钙化组血钙、血磷、钙磷乘积、PTH水平高于无钙化组和Ⅰ度钙化组(P<0.05),Ⅲ度钙化组血磷、钙磷乘积及PTH水平明显高于Ⅱ度钙化组(P<0.05)。(3)HD组治疗前后血钙、血磷、PTH比较差异无统计学意义(P>0.05)。HDF组、HP+HD组治疗后血钙较治疗前升高,血磷及PTH下降,差异有统计学意义(P<0.05)。治疗后3组患者血钙比较差异无统计学意义(P>0.05)。治疗后HDF组和HP+HD组的血磷、PTH水平明显低于HD组(P<0.05);HP+HD组的血磷及PTH水平与HDF组比较明显降低,差异有统计学意义(P<0.05)。结论高磷血症、高PTH等是心脏瓣膜钙化的高危因素,应用HDF、HP+HD透析方式能较好地清除血磷、PTH等,以HP+HD透析方式尤佳,可降低心脏瓣膜钙化率。Objective To investigate the cardiac valve calcification in maintenance hemodialysis patients,and to analyze the risk factors of cardiac valve calcification in different blood purification techniques. Methods Fifty-four maintenance hemodialysis patients with chronic renal failure in the people′s hospital of Taixing were enrolled and were divided into blood hemodialysis（HD） group,hemodiafiltration（HDF） group,and tandem hemodialysis hemoperfusion（HP＋HD） group.Eighteen cases in each group.The serum levels of calcium,phosphate,parathyrine（PTH） were detected and the degree of cardiac valve calcification was observed.The relationships of calcium,phosphate,calcium×phosphate,PTH and the calcification of cardiac valves were analysed. Results（1）After treatment for 12 months,there were 23 patients had cardiac valve calcification,and total morbidity rate was 42.59%.In HD group the morbidity rate was 55.56%,in HDF group the morbidity rate was 44.44%,while 27.78% in HP＋HD group.There were significant differences among three groups（P0.05）.（2） After treatment for 12 months,the levels of phosphate,calcium×phosphate and PTH of calcification in gradeⅠgroup were higher than non calcification group（P0.05）;the levels of calcium,phosphate,calcium×phosphate and PTH of calcification in grade Ⅱ、Ⅲ group were higher than non calcification group and calcification in gradeⅠgroup（P0.05）;the levels of phosphate,calcium×phosphate and PTH of calcification in grade Ⅲ group were higher than calcification in gradeⅡgroup（P0.05）.（3）There were no differences in the levels of calcium,phosphate and PTH in HD group before and after treatment（P0.05）.Compared with before treatment,the level of calcium in HDF group and HP＋HD group increased,but levels of sphosphate and PTH decreased after treatment（P0.05）.There was no significant difference in calcium among the three group（P0.05）.After treatment,the levels of phosphate and PTH in HDF group and HP＋HD group were lower than thos

关 键 词：血液透析 血液滤过 血液灌流 心脏瓣膜钙化 

分 类 号：R542.5[医药卫生—心血管疾病]