广东省贫困地区维持性血液透析人群矿物质及骨代谢异常现况——梅州市五华县横断面调查  

Mineral and bone disorder in maintenance hemodialysis patients in disadvantaged areas of Guangdong Province： a cross-sectional study from Wuhua County of Meizhou City

作　　者：张裕生[1] 陈源汉[2] 李志莲[2] 郑锐[1] 曾鹏飞[1] 钟丽红[1] 梁馨苓[2] 史伟[2] 

机构地区：[1]广东省梅州市五华县人民医院内二科,梅州514400 [2]广东省人民医院肾内科广东省医学科学院

出　　处：《国际移植与血液净化杂志》2014年第5期26-30,共5页International Journal of Transplantation and Hemopurification

基　　金：国家临床重点专科建设项目;国家十二五科技支撑计划项目（2011BA110806）

摘　　要：目的了解广东省贫困地区血液透析人群矿物质及骨代谢异常的流行病学情况。方法在广东省特困县梅州市五华县进行横断面调查。检测维持性血液透析患者的生化指标和全段甲状旁腺激素，访谈式问卷调查患者对矿物质及骨代谢异常的知晓情况和饮食习惯。结果调查46例患者，年龄（46±11）岁，均为客家人，80．4％为农村人口，中位透析时间35月，每2周中位透析次数4次。根据K／DOQI指南推荐标准，本组对象中41．3％血钙达标，但血磷和全段甲状旁腺激素分别只有6．5％和19．6％达标，没有3项指标同时达标的患者。在43例完成问卷调查的患者中，知晓甲状旁腺激素、肾性骨病、低磷饮食和药物降磷的比例分别为44．2％、55．8％、53．5％和69．8％；有喝肉汤习惯、没有控制肉类摄入、饮奶制品习惯和进食豆类习惯的比例分别为58．1％、46．5％、28．3％和21．7％。结论广东省贫困地区透析人群中防治矿物质及骨代谢异常的工作开展仍不充分。经济和医疗条件落后、健康宣教不足、患者遵医依从性低以及客家地区特殊的饮食习惯是这一地区开展矿物质及骨代谢异常健康管理面临的挑战。Objective To study the epidemic of mineral and bone disorder （MBD） in disadvantaged areas of Guangdong Province. Methods A cross-sectional investigation was conducted in a poor county of Wuhua County. Biochemical indicators and intact parathyroid hormone （iPTH） was determined, and knowledge about MBD concept and diet habit was investigated through interview questionnaire. Results Forty-six Hakkas patients were investigated, aged （46 ±11） years, 80.4% from rural population, with a median of hemodialysis vintage of 35 months and a median of dialysis frequency of 4 times per two weeks. According to the K/DOQI criteria, 41.3% qualified the optimal calcium standard, while only 6.5% and 19.6 % reached the optimal standard of phosphate and iPTH. None was up to the optimal standard of all the 3 indices. In the 43 patients who completed the interview questionnaire, the awareness rate of of ffq]-I, renal osteodystrophy, low phosphorus diet and phosphate binder was 44.2 %, 55.8 %, 53.5 % and 69.8 %, respectively; and the rate of diet habits of meat soup, meat intake without control, and milk and soybeans intake was 58.1%, 46.5%, 28.3% and 21.7%, respectively. Conclusions The performance of MBD in hemodialysis patients is not satisfied in disadvantaged areas of Guangdong Province. Poor economic and medical conditions, insufiqcient health education, poor compliance and traditional Hakka cuisine contribute to the challenge of local MBD health management.

关 键 词：矿物质及骨代谢异常 血液透析 流行病学 客家学 甲状旁腺机能亢进症 高磷血症 健康教育 

分 类 号：R459.5[医药卫生—治疗学]