慢性肾脏病非透析患者钙磷代谢紊乱的相关性分析  

Correlation Analysis of Calcium and Phosphorus Metabolism in the Non-dialysis Patients with Chronic Kidney Disease

作　　者：张家珍[1] 邹新蓉[2] 王小琴[2] 韩四萍[2] 

机构地区：[1]湖北中医药大学研究生院,湖北武汉430061 [2]湖北省中医院肾病科

出　　处：《华南国防医学杂志》2016年第5期312-315,共4页Military Medical Journal of South China

基　　金：卫生部行业科研专项项目(201002010)

摘　　要：目的探查慢性肾脏病（chronic kidney disease,CKD）3~5期非透析患者钙磷代谢的水平,了解其紊乱程度,并进行相关因素分析,总结临床特点,为临床防治矿物质-骨代谢紊乱（minerals-bone metabolism disorders,MBD）提供依据,并为相关研究提供借鉴。方法收集湖北省中医院肾病营养门诊规律性随访的145例CKD 3~5期非透析患者的一般临床资料并检测血钙、血磷、血肌酐（serum creatinine,Scr）、甲状旁腺激素（parathyroid hormone,PTH）、以及碱性磷酸酶（alkaline phosphatase,ALP）等相关实验室指标,按分期比较患者钙磷等指标的水平及其紊乱的发生率,对各项结果进行统计学分析。结果 1以患者各生化指标水平为对象统计分析：处于3期和4期血钙水平无统计学差异（P〉0.05）,而CKD 5期患者的血钙水平显著低于CKD 3期和CKD 4期,组间差异具有统计学意义（P〈0.05）;各期患者的血磷、钙磷乘积以及PTH水平均随分期逐渐升高。而各期的ALP水平差异无统计学意义（P〉0.05）。2低血钙症、高磷血症、高PTH血症以及钙磷乘积〉55发生率的差异有统计学意义（P〈0.01）,随分期呈递增趋势,3期最低,5期最高。3相关性分析：患者PTH水平与血磷（r=0.516,P〈0.01）、钙磷乘积（r=0.474,P〈0.01）成正相关;与钙（r=-0.405,P〈0.01）、肾小球滤过率（glomerular filtration rate,GFR）（r=-0.551,P〈0.01）成负相关;与ALP无相关性。并且,血清钙、血清磷以及肾小球滤过率均是PTH独立影响因素（R=0.575,P〈0.05）。结论慢性肾脏病患者钙磷代谢紊乱在早期即可出现,尤其4期以后紊乱情况明显增加,不仅加重患者的病情,影响其CKD进展,还严重影响其生活质量,更重要的是加快其死亡进程,降低患者生存率,故应重视,加强早期干预、及时治疗,减轻临床症状,延缓病情的进展,减少死亡率,改善预后。Objective To investigate the chronic kidney disease（ CKD） of calcium and phosphorus metabolism in nondialysis patients with 3-5 level,understand the degree of disorder,and analyze the related factors,to summarize the clinical characteristics,for the prevention and treatment of bone mineral metabolism（ Minerals-bone metabolism disorders,MBD） to provide the basis,and provide reference for related research. Methods Clinic regularity of the 145 follow-up cases of non dialysis CKD3-5 patients with clinical data（ name,age,weight,primary disease,medication,etc.） from authors’ hospital and to detect the related laboratory indexes include calcium,blood phosphorus,blood creatinine（ serum creatinine,Scr）,parathyroid hormone（ PTH） and alkaline phosphatase（ ALP）,according to the incidence of staging of patients with calcium phosphorus and other indicators and level of disorder,the results were analyzed. Results The blood calcium level of 3 and 4 with no significant difference（ P 〉 0. 05）,and CKD 5 patients had significantly lower serum calcium levels than CKD 3（ P 〈 0. 01） that of CKD 4 patients（ P 〈 0. 05）; the product of calcium and phosphorus and PTH levels of patients were gradually increased with the stages（ P〈 0. 01）. But there was no obvious difference in each period ALP level（ P 〉 0. 05）. The hypocalcemia,hyperphosphatemia,high serum PTH and the incidence rate of calcium phosphorus product 〉 55 were statistically significant（ P 〈 0. 01）,with the stage of increasing trend,the lowest 3 level,highest 5 level. The correlation analysis： the level of PTH and serum phosphorus（ r= 0. 516,P 〈 0. 01）,calcium and phosphorus product（ r = 0. 474,P 〈 0. 01） were positively correlated; and calcium（ r =0. 405,P 〈 0. 01）,glomerular filtration rate（ GFR）（ r = 0. 551,P 〈 0. 01）. A significant negative correlation： ALP had no correlation with it. And serum calcium,serum phosphorus and glomerular filtration rate were the independent influence f

关 键 词：慢性肾脏病 血钙 血磷 甲状旁腺激素 

分 类 号：R692[医药卫生—泌尿科学]