腹膜透析并发甲状旁腺功能亢进患者的认知功能及其相关因素分析  

Cognitive status and influencing factors in maintenance dialysis patients with secondary hyperparathyroidism

作　　者：刘桂凌[1] 李丹丹[1] 王瑞峰[1] 王雪荣[1] 陈晓莉[1] 郝丽[1] 

机构地区：[1]安徽医科大学第二附属医院肾内科,合肥230601

出　　处：《临床肾脏病杂志》2016年第2期76-80,共5页Journal Of Clinical Nephrology

基　　金：安徽医科大学2015年度临床科学研究项目基金资助(NO.2015xkj111)

摘　　要：目的探讨维持性腹膜透析并发甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者的认知功能及其影响因素。方法选择安徽医科大学第二附属医院透析时间超过3个月的维持性腹膜透析患者为研究对象并筛选出2组患者,A组21例患者的甲状旁腺激素(parathyroid hormone,PTH)<630 ng/L合并骨痛、皮肤瘙痒等不适症状,B组45例患者的PTH>630 ng/L未合并骨痛、皮肤瘙痒等不适症状。对每例患者详细询问病史并测定血常规、生化常规、电解质、甲状旁腺激素、25-羟维生素D_3[25(OH)D_3]等的检查,并在血液检查1周内采用智能评估量表(the modified mini-mental assessment amount,3MS)进行认知评分,分析2组患者临床指标间的差异及3MS得分的相关因素。结果 A组患者的血红蛋白(hemoglobin,Hb)、血肌酐(SCr)、血钙、25(OH)D_3及3MS得分等均高于B组,差别有统计学意义(均P<0.05);A组患者的血磷、PTH水平等低于B组,差别有统计学意义(均P<0.05)。相关性因素分析发现A组患者的3MS得分与年龄(r=-0.657,P=0.001)、有无脑血管疾病病史(r=-0.512,P=0.018)、PTH(r=-0.652,P=0.001)呈负相关,差别有统计学意义。B组患者的3MS得分男性高于女性,差别有统计学意义(r=-0.344,P=0.021)。3MS得分与Ca(r=0.958,P=0.000)、25(OH)D_3(r=0.983,P=0.000)呈正相关,与年龄(r=-0.804,P=0.000)、有无脑血管疾病病史(r=-0.425,P=0.000)、血磷(r=-0.965,P=0.000)、PTH(r=-0.941,P=0.000)呈负相关。多因素STEPWISE法回归分析发现,25(OH)D3(t=6.298,P=0.000)、血钙(t=3.233,P=0.002)、PTH(t=-2.632,P=0.012)是3MS得分的独立危险因素。结论维持性腹膜透析并发SHPT患者的整体认知水平与患者的性别、年龄、脑血管疾病史、血钙、血磷及25(OH)D_3水平及PTH等有关,改善维持性腹膜透析合并甲状旁腺功能亢进患者体内的钙磷代谢紊乱、降低血甲状旁腺激素水平也许是提高患者认知功能的重要手段。Objective To investigate the cognitive status and influencing factors in maintenance dialysis patients with hyperparathyroidism. Methods According to the level of parathyroid hormone and clinical symptoms, patients with duration of peritoneal dialysis 93 months were divided into PTH 〈630 ng/L group （group A, no-combined bone pain and skin itchy） and PTH 〉630 ng/L group （group B, combined bone pain and skin itchy）. Detailed history was asked and blood routine, biochemical routine, electrolytes, parathyroid hormone, and 25-dihydroxy vitamin D3 were determined. Cognitive function was assessed using the modified mini-mental assessment amount （3MS） table in a week after blood tests. The differences in gender, age, history of cerebrovascular disease, hemoglobin, serum creatinine, blood urea nitrogen, uric acid, albumin before, serum albumin, calcium, phosphorus, parathyroid hormone, 25-hydroxy vitamin D3 and 3MS score were analyzed between two groups. The correlations between the 3MS score and other measurement indicators were analyzed. Results There was no significant difference （P〈0. 05） between two groups in the patient＇s gender, age, history of cerebrovascular diseases, serum creatinine, blood urea nitrogen, uric acid, the former plas- ma albumin, and plasma albumirL The levels of hemoglobin, serum calcium, 25-hydroxyvitamin D3 levels and 3MS scores in group A were significantly higher than in group B （P〈0. 05）. The levels of serum phosphorus and serum parathyroid hormone in group B were significantly higher than in group A （P〈0. 05）. In group A, correlation analysis showed that the 3MS score was negatively correlated with age, the history of cerebral vascular disease and parathyroid hormone levels. In group B, correlation analysis showed that the 3MS score was positively correlated with serum calcium and concentration level of 25-hydroxyvitamin I33, but negatively correlated with age, the history of cerebrovascular disease, serum phosphate levels and parathyroid hormone levels,

关 键 词：腹膜透析 继发性甲状旁腺功能亢进 认知功能 25羟维生素D3 

分 类 号：R692.5[医药卫生—泌尿科学] R582.1[医药卫生—外科学]