血液透析患者矿物质和骨代谢紊乱控制情况的单中心研究  

Mineral and bone disorders in hemodialysis patients:a single center study

作　　者：孔祥雷[1] 宝群[1] 魏勇[1] 贾晓妍[1] 陈萍[1] 唐利军[1] 王尊松[1] 李文斌[1] 崔美玉[1] 许冬梅[1] 

机构地区：[1]山东大学附属千佛山医院肾内科,济南250014

出　　处：《山东大学学报（医学版）》2012年第8期116-119,共4页Journal of Shandong University:Health Sciences

摘　　要：目的探讨血液透析患者矿物质和骨代谢紊乱的控制情况。方法从本院透析中心选取规律血液透析的患者共91例进行横断面研究,收集其临床资料、用药情况,检测矿物质代谢的指标。根据2003年美国肾脏病生存质量指导指南建议,与透析预后及实践模式(DOPPS 4)研究作比较,分析血液透析患者矿物质代谢紊乱的控制情况及相关因素。结果血透患者血钙、血磷、甲状旁腺激素(iPTH)的达标率分别为58.2%、49.5%和34.1%,与DOPPS4的研究结果(血钙、血磷及iPTH的达标率分别为56.0%、54.5%和32.1%)比较差异无统计学意义(P>0.05)。Logistic回归分析显示,年龄(优势比OR值:0.96,95%CI:0.94～0.99)和血清前白蛋白(优势比OR值:1.01,95%CI:1.0～1.02)与高磷血症独立相关。结论血液透析患者的矿物质代谢紊乱控制情况与发达国家相似,但高磷血症的问题更加突出,应引起进一步重视。Objective To explore the spectrum of mineral and bone disorders among hemodialysis patients.Methods Ninety-one maintenance hemodialysis patients from our dialysis center were included in the study.Markers of mineral and bone disorders,including plasma phosphorus（P）,calcium（Ca） and intact parathyroid hormone（iPTH） were measured among ninety-one patients receiving hemodialysis.The controlling rates of those markers were compared with the results in the Dialysis Outcomes and Practice Study（DOPPS） 4 study.Factors associated with hyperphosphatemia were examined.Results According to the Kidney Disease Outcomes Quality Initiative target for plasma P,Ca and iPTH levels,the percentages of patients with controlled Ca（58.2% vs 56.0%）,P（49.5% vs 54.5%） and iPTH（34.1% vs 32.1%） were not statistically different compared with those in the DOPPS 4 study.The percentage of hemodialysis patients with serum phosphorus level above 5.5 mg/dL was 42.9%.Age（odd ratio 0.96,95% confidence interval： 0.94-0.99） and pre-albumin（odd ratio 1.01,95% confidence interval： 1.0-1.02） were independently associated with hyperphosphatemia.Conclusion Status of mineral and bone disorders is relatively optimal among our hemodialysis patients compared with those in the DOPPS 4 study.Hyperphosphatemia is prominent and needs further attention.

关 键 词：终末期肾脏病 矿物质 骨疾病 代谢性 流行病学 血液透析 

分 类 号：R692.5[医药卫生—泌尿科学]