维持性血液透析患者甲状旁腺增生的影响因素  

Influence factors of parathyroid hyperplasia during maintenance hemodialysis

作　　者：马骏骉[1] 陈岚[1] 刘凤菊[2] 卞维静[1] 勇强[2] 程虹[1] 

机构地区：[1]首都医科大学附属北京安贞医院肾内科北京市心肺血管疾病研究所,100029 [2]首都医科大学附属北京安贞医院超声科,100029

出　　处：《中国医药》2014年第11期1624-1628,共5页China Medicine

摘　　要：目的 探讨维持性血液透析患者甲状旁腺增生的影响因素.方法 对北京安贞医院肾内科维持性血液透析治疗1年以上的71例患者进行甲状旁腺超声检查,根据患者是否存在甲状旁腺增生分为甲状旁腺增生组（33例）和甲状旁腺非增生组（38例）.统计分析甲状旁腺增生与患者年龄、透析时间及血钙（校正钙）、血磷、全段甲状旁腺激素（iPTH）、总碱性磷酸酶（ALP）、25-羟维生素D等指标之间的关系.结果 有71例患者接受甲状旁腺的超声检查,其中甲状旁腺增生组的患者占46.5％（33/71）,非增生组患者占53.5％（38/71）,2组间透析时间、血磷、iPTH水平差异有统计学意义[（64±40）个月比（44 ±33）个月,（2.2±0.5） mmol/L比（2.0±0.5） mmol/L,600（505,1 060） ng/L比299（191,433） ng/L]（P＜0.05或P＜0.01）.对年龄、透析时间及血钙、血磷、ALP、iPTH、25-羟维生素D水平的单因素分析结果显示,甲状旁腺增生与透析时间、血磷、iPTH、ALP呈正相关（r=0.293,r=0.533,r=0.269,r=0.308,P＜0.05）;对上述指标进行Logistic回归分析显示仅iPTH与甲状旁腺增生存在独立相关性（P＜0.05）.受试者工作特征曲线分析表明iPTH水平能高度提示甲状旁腺增生,曲线下面积及95％置信区间为0.852（0.757 ～0.946）,对应界定值为513 ng/L,相对应的敏感度为75.8％,特异性为86.8％.结论 维持性血液透析患者的透析时间、血磷是甲状旁腺增生的影响因素,而iPTH大于513 ng/L提示存在甲状旁腺增生.Objective To evaluate the influence factors of parathyroid hyperplasia in the maintenance hemodialysis（MHD） patients.Results A total of 71 MHD patients from March 2012 to March 2013 were included in this study.The patients were divided into parathyroid hyperplasia group（33 cases） and non-hyperplasia group （38 cases）.The relation among parathyroid hyperplasia,duration of dialysis,serum calcium,phosphorus,parathyroid hormone （intact parathyroid hormone,iPTH）,total alkaline phosphatase,and 25-hydroxy vitamin D levels were analyzed.Finally,receiver operating characteristic（ROC） curve was done to find out the boundary values of diagnosis parathyroid hyperplasia.Results Between the two groups,blood phosphorus,duration of dialysis and iPTH had statistical differences [（64 ± 40） months vs （44 ± 33） months,（2.2 ± 0.5） mmol/L vs （2.0 ± 0.5） mmol/L,600 （505,1 060） ng/L vs 299 （191,433） ng/L] （P 〈 0.05 or P 〈 0.01）.Logistic regression analysis indicated that iPTH had independent correlation with parathyroid hyperplasia.ROC curve indicated that using iPTH to prompt the standard of parathyroid hyperplasia was accurate.The boundary level of iPTH prompting parathyroid hyperplasia was 513 ng/L.Conclusions Parathyroid hyperplasia is correlated with duration of dialysis and serum phosphorus.If level of iPTH is greater than 513 ng/L,it highly suggests hyperplasia of parathyroid.

关 键 词：维持性血液透析 甲状旁腺增生 影响因素 

分 类 号：R318.16[医药卫生—生物医学工程]