维持性血液透析患者钙磷代谢紊乱的影响因素及其与肾性贫血的相关性  

Related factors of calcium and phosphorus metabolism disorders in maintenance hemodialysis patients and the correlation with renal anemia

作　　者：陈续红 刘帝[2] 刘烨歆 谭夏[2] 李慧琼[2] 刘海洋[2] 袁芳[2] 贺理宇[2] 陈星[2] 刘虹[2] 

机构地区：[1]湖南省湘潭市第二人民医院肾内科,411100 [2]中南大学湘雅二医院肾内科,长沙410011

出　　处：《临床肾脏病杂志》2016年第12期728-733,共6页Journal Of Clinical Nephrology

摘　　要：目的调查我院血液透析中心患者钙磷代谢标志物血钙、血磷、全段甲状旁腺素（intact parathyroid hormone，iPTH）等指标的达标情况，探讨维持性血液透析患者钙磷代谢紊乱的影响因素及其与肾性贫血的关系，以便更好的控制钙磷代谢紊乱并管理贫血。方法研究纳入2010年1月至2015年1月在我院血液透析中心规律行血液透析（透析时间〉／3个月）的终末期肾病患者作为研究对象，收集患者年龄、性别、透析时间、透析频率、残余尿量等相关资料及患者血钙、血磷、iPTH、血红蛋白（hemoglobin，Hb）等实验室检查指标，统计我院血液透析中心患者钙磷代谢标志物血钙、血磷、iPTH等各项指标的达标情况。然后分别根据年龄、透析龄、透析频率、残余尿量进行分组，比较各组间钙磷代谢指标的差异性，再分别根据血钙、血磷和iPTH进行分组，采用趋势卡方检验及方差分析比较各组间Hb达标情况。结果①本血液透析中心263例患者中，血钙达标率45．0％，血磷达标率40．1％，iPTH达标率23．7％，与透析预后与实践模式研究第4阶段（Dialysis Outcomes and Practice Pattern Study，DOPPS4）国家达标数据（56．0％、54．5％、32．1％）比较，达标率存在一定差距。②根据透析龄进行分组，透析龄≥3年组平均血钙水平显著高于透析龄〈3年组平均血钙水平；根据透析频率进行分组，每周〉2次透析组平均血钙水平显著高于每周≤2次透析组平均血钙水平，血磷水平显著低于每周≤2次透析组。根据残余尿量进行分组，有尿组（尿量≥100ml／24h）钙磷乘积显著低于无尿组。根据年龄分组，年龄〉45岁组平均血磷水平、iPTH水平、钙磷乘积水平显著低于年龄≤45岁组。③将血钙浓度分为〈2．1mmol／L、2．1～2．5mmol／L、〉2．5mmol／L三组。随着血钙增高，Hb达标（≥110g／L）人数占比越来越Objective To investigate the calcium and phosphorus metabolic disorders in mainte- nance hemodialysis patients and analyze the correlation between renal anemia and calcium and phos- phorus metabolic disorders in hemodialysis patients in our dialysis center in order to better control cal-cium and phosphorus metabolism disorders in hemodialysis patients. Methods This study was performed in end stage renal disease（ESRD） patients who underwent regular hemodialysis （more than 3 months） in our dialysis center, by the end of January 2015. Patients＂ general information was collected, including age, gender, duration and frequency of dialysis, residual urine volume, use of medicines. Laboratory indexes including serum calcium, serum phosphorus, iPTH and hemoglobin were collected in order to evaluate the rate of standard-reached. According to patients＂ age, gender, duration and frequency of dialysis and residual urine volume, patients were divided into different groups to analyze the difference in serum calcium and phosphorus. Then the patients were subgrouped by serum calcium, serum phosphorus and iPTH. Data were analyzed by trend chi-square test and variance. Results （1） Based on the study of 263 patients undergoing hemodialysis in our dialysis center, we found a gap between the DOPPS4 compliance data （56. 0%, 54. 5 %, and 32. 1%） and our observation in which serum calcium reached 45%, serum phosphorus level reached 40. 1% and iPTH reached 23. 7%, respectively. （2） The study on the subgroups of hemodialysis duration indicated that subjects who had a minimum of three-year hemodialysis duration, on average, had a much higher serum calcium level than those whose hemodialysis duration was less than three years. The study on the subgroups of hemodialysis frequency indicated that subjects who received dialysis over twice per week, on average, had a much higher serum calcium level than those whose hemodialysis frequency was less than twice at most per week. The study on the subgroups of residual urine vol

关 键 词：血液透析 钙磷代谢 肾性贫血 血钙 血磷 

分 类 号：R692.5[医药卫生—泌尿科学]