维持性血液透析患者代谢性酸中毒对钙磷代谢的影响  

Metabolic acidosis and its effect on calcium and phosphorus metabolism in maintenance hemodialysis patients

作　　者：黎晓磊[1] 邵咏红[1] 孔耀中[1] 

机构地区：[1]中山大学附属佛山医院/佛山市第一人民医院肾内科,广东省佛山市528000

出　　处：《实用医学杂志》2012年第19期3219-3222,共4页The Journal of Practical Medicine

摘　　要：目的:分析比较维持性血液透析(MHD)患者的代谢性酸中毒对钙磷代谢的影响。方法:选择MHD患者120例,测定透析前碳酸氢根(HCO3-)、血尿素氮(BUN)、肌酐(CR)、钙(Ca)、磷(P)、碱性磷酸酶(ALP)、甲状旁腺激素(iPTH)及透析后BUN和CR,计算钙磷乘积(Ca×P)、Kt/V。根据HCO3-分为3组:A组(HCO3-<20mmol/L)、B组(HCO3-为20～24mmol/L)和C组(HCO3-≥24mmol/L),比较3组酸中毒对钙磷紊乱的影响。结果:B、C组的P、ALP及iPTH均低于A组(P<0.05),C组的P、Ca×P低于A、B组(P<0.05)。HCO3-浓度与P、iPTH、ALP及Ca×P呈负相关(P<0.05)。结论:对于MHD患者,HCO3-<20mmol/L较HCO3-≥20mmol/L者易合并高磷血症、低钙血症,可刺激iPTH的合成,最终导致肾性骨病及转移性钙化。Objective To evaluate the effect of metabolic acidosis on calcium and phosphorus metabolism in maintenance hemodialysis（MHD） patients. Methods 120 MHD patients were enrolled in the present study. Predialysis laboratory detections including HCO3-, BUN creatinine, calcium, phosphorus, alkaline phosphatase （ALP） and intact parathyroid hormone （iPTH） were performed. Calcium-phosphate product and Kt/V were also determined. The patients were randomized into 3 groups： group A（HCO3- 〈 20 mmol/L）, group B （20 mmol/L ≤HCO3- 〈 24 mmoL/L）, group C （HCO3- ≥ 24 mmol/L）. Results The concentrations of phosphorus, ALP and iPTH were decreased in groups B and C in comparation to that in group A （P 〈 0.05）. Compared with group A and B, the phosphorus and calcium-phosphate product level in group C were decreased （P 〈 0.05）. The serum HCO3- level correlated negatively with the serum phosphorus, iPTH, ALP and calcium-phosphate product （P 〈 0.05）. Conclusions Correction of metabolic acidosis （bicarbonate level≥ 20 mmol/L） may prevent the deleterious long-term consequences such as CKD-MBD, but further investigation of the long-term effect still needs to be done.

关 键 词：肾透析 代谢性酸中毒 钙磷代谢 

分 类 号：R692.5[医药卫生—泌尿科学]