维持性血液透析患者矿物质和骨代谢紊乱与血清hs-CRP水平的关系  

Association between mineral and bone metabolism disorder and serum hs-CRP level in maintenance hemodialysis patients

作　　者：谢庆军[1] 周静文[1] 吴卓媚[1] 李科慧[1] 周红卫[1] 谢恺庆[1] 

机构地区：[1]广西医科大学第一附属医院,南宁530021

出　　处：《山东医药》2016年第45期31-33,共3页Shandong Medical Journal

基　　金：广西自然科学基金项目(2013GXNSFAA019149);广西高校科研立项项目(201204LX054)

摘　　要：目的探讨维持性血液透析（MHD）患者矿物质和骨代谢紊乱与血清高敏C-反应蛋白（hs-CRP）水平的关系。方法采用单中心横断面研究,共纳入MHD患者215例。检测患者的血清hs-CRP以及矿物质和骨代谢指标血清钙（Ca）、磷（P）、全段甲状旁腺素（i PTH）,并与2009年KDIGO指南所推荐的有关慢性肾脏病MBD的指标范围比较,分析Ca、P、i PTH、钙磷乘积（Ca×P）与血清hs-CRP水平的关系。结果 215例MHD患者中54例同时达到KDIGO推荐的血清Ca、P、i PTH三项指标目标值,占25.1%。达标组hs-CRP较未达标组低（4.5 mg/L比7.3 mg/L,P〈0.05）。患者的血清P与hs-CRP正相关（r=0.170,P〈0.05）,血清血红蛋白（Hb）、白蛋白（Alb）与hs-CRP负相关（r分别为-0.152、-0.158,P均〈0.05）,hs-CRP与血清Ca、i PTH、Ca×P及透析时间、年龄无相关性（P均〉0.05）。多元逐步回归分析显示,血清P、Alb是hs-CRP的独立影响因素（P均〈0.05）。Logistic回归分析示血清P是炎症状态的独立危险因素（OR=1.602,95%CI 1.068-2.401,P=0.023）,血清Alb是炎症状态的保护因素（OR=0.940,95%CI 0.890-0.993,P=0.027）。结论矿物质和骨代谢紊乱与MHD患者血清hs-CRP水平升高密切相关;高磷血症是MHD患者hs-CRP水平升高的独立危险因素。Objective To investigate the association between mineral and bone metabolism disorders and serum highsensitivity C-reactive protein（ hs-CRP） level in maintenance hemodialysis（ MHD） patients. Methods Totally 215 MHD patients were enrolled in this cross-sectional study. Serum hs-CRP,and biomarkers of mineral and bone disorder,including serum calcium,serum phosphorus and intact parathyroid hormone（ i PTH）,were measured and compared with the recommended range in the KDIGO guidelines. The correlations between hs-CRP and the biomarkers（ Ca,P,i PTH and Ca × P）of mineral and bone disorder were analyzed. Results In 215 MHD patients,54 cases（ 25. 1%） all met the standard of the guideline range including Ca,P and i PTH（ the standard group）,and this group had lower hs-CRP level than that of the non-standard group（ 4. 5 mg/L vs 7. 3 mg/L,P〈0. 05）. The serum hs-CRP level was positively correlated with serum phosphorus（ r = 0. 170,P〈0. 05）,and was negatively correlated with hemoglobin（ r =-0. 152,P〈0. 05）,and serum albumin（ r =-0. 158,P〈0. 05）. Multiple stepwise regression analysis revealed that serum phosphorus and serum albumin were were independent risk factors for hs-CRP. Logistic regression analysis showed that serum phosphorus was an independent risk factor（ OR = 1. 602,95% CI 1. 068-2. 401）,whereas serum albumin was a protective factor for the inflammatory state（ OR = 0. 940,95% CI 0. 890-0. 993）. Conclusions There is a close association between mineral and bone disorder and serum hs-CRP level in MHD patients. Hyperphosphatemia is an independent risk factor for the increased hs-CRP levels in MHD patients.

关 键 词：血液透析 矿物质和骨代谢紊乱 炎症 C反应蛋白质 

分 类 号：R459.5[医药卫生—治疗学]