低钙透析对低甲状旁腺激素血液透析患者矿物质及骨代谢的影响  

Effects of lowering dialysate calcium concentration on mineral metabolism and bone turnover in patients with low level of parathyroid hormone on hemodialysis

作　　者：马丽洁[1] 李忠心[1] 刘婧[1] 赵素梅[1] 

机构地区：[1]首都医科大学附属北京朝阳医院肾内科,北京100020

出　　处：《首都医科大学学报》2016年第2期228-232,共5页Journal of Capital Medical University

摘　　要：目的低钙透析对低甲状旁腺激素血液透析患者甲状旁腺激素及骨代谢的影响。方法选取70例血清全段甲状旁腺激素(intact parathyroid,i PTH)<100 pg/m L的维持性血液透析患者。应用1.25 mmol/L钙浓度透析液进行血液透析治疗,随访1年。常规检测生化指标——血钙、血磷、血清碱性磷酸酶(alkaline phosphatase,ALP),化学发光法检测i PTH、骨钙素(osteocalcin,OC)、I型前胶原氨基末端前肽(procollagen type I amino-terminal propeptide,PINP)、β胶原蛋白(β-crosslaps,β-CTX),观察患者应用1.25 mmol/L钙浓度透析液前及应用后1、3、6、12个月时血钙、血磷、ALP、i PTH变化以及OC、PINP、β-CTX等骨代谢指标的变化。结果 1)血清i PTH浓度于应用1.25 mmol/L钙浓度透析液3个月后显著升高(P<0.001);2)更换透析液后各时间点与更换前比较,血清OC浓度、PINP浓度及β-CTX浓度于更换1个月后显著升高,差异有统计学意义(P<0.001);3)OC浓度变化与年龄呈负相关(r=-0.816,P<0.001)、与基线i PTH浓度呈正相关(r=0.673,P=0.037);β-CTX浓度变化与年龄呈负相关(r=-0.718,P<0.001)、与基线i PTH浓度吴正相关(r=0.651,P=0.020);4)更换透析液前基线血清i PTH浓度(P<0.001)、糖尿病史(P=0.012)是i PTH改善的独立影响因素。结论低钙透析可以改善低甲状旁腺激素患者i PTH浓度,升高OC、PINP及β-CTX浓度,增加骨代谢,是治疗低转运骨病的有效方法。Objective To observe the effect of dialysate with lowering calcium concentration on mineral metabolism and bone turnover in patients with low level of parathyroid hormone on hemodialysis. Methods Total 70 patients with i PTH 〈 100 pg / m L were treated with DCa-1. 25 mmol / l dialysate for 1 year. Serum calcium,phosphorus,alkaline phosphatase（ ALP） levels were determined by standard method. Their levels of serum intact parathyroid（ i PTH）,osteocalcin（ OC）,procollagen type I amino-terminal propeptide（ PINP）,β-crosslaps（ β-CTX） were measured by Chemiluminescence. i PTH,OC,PINP,β-CTX,serum calcium,phosphorus,ALP were measured before and 1,3,6,12 months after the change of dialysate. Results After lowering D-Ca,serum i PTH levels progressively increased at 3months（ P 〈 0. 001）,and serum OC,PINP,β-CTX levels increased at 1 months（ P 〈 0. 001）. In correlation analyses,the changes in OC and β-CTX correlated positively with baseline i PTH（ OC ： r = 0. 673,P = 0. 037; β-CTX： r = 0. 651,P = 0. 020）,and correlated negatively with age（ OC ： r =- 0. 816,P 〈 0. 001; β-CTX： r =- 0. 718,P 〈 0. 001）. In Logistic regression analysis,baseline i PTH,diabetes were independent factors of the improvement of i PTH level. Conclusion Dialysate with lowering calcium concentration can improve PTH levels and stimulate bone metabolism.

关 键 词：骨代谢 低钙透析 低甲状旁腺激素 血液透析 

分 类 号：R692[医药卫生—泌尿科学]