CKD-MBD临床管理目标值的探索:血钙血磷和PTH  

Studies on the target values of serum calcium, phosphorus and PTH for the treatment of chronic kidney disease-mineral and bone disorder

作　　者：范亚平[1] 

机构地区：[1]南通大学附属医院肾内科血液净化中心,南通226001

出　　处：《中国血液净化》2017年第6期367-369,426,共4页Chinese Journal of Blood Purification

摘　　要：慢性肾脏病-矿物质和骨异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)是(chronic kidney disease,CKD)进展过程中常见的并发症,与CKD患者住院率增加、生活质量下降、心血管钙化和心血管死亡率及全因死亡率增高密切相关,明确CKD-MBD相关的血钙、血磷及甲状旁腺激素(parathyroid hormone,PTH)等指标的控制靶目标范围是临床工作者关注的焦点,国内外亦已提出相应指南或共识建议。总体而言,各指南或共识对血磷和血钙的靶目标值基本一致,即尽可能达到和维持在正常参考值范围,钙磷乘积主要受血磷水平的影响,意义相对较小,但对PTH的靶目标值有较大范围波动,特别是KDIGO指南提出将全段甲状旁腺激素(intact parathyroid hormone,i PTH)控制于正常参考值上限约2~9倍引发了关注和争议,然目前已发表的研究结果尚不能给定较为狭窄的范围。在临床实践中CKD-MBD相关指标的动态变化趋势远比孤立的单次数值更有判断价值和指导意义。Chronic kidney disease-mineral and bone disorder （CKD-MBD） is a common compucauon during the progression of CKD, closely relating to the hospitalization rate, poor quality of life, cardiovascular calcification and cardiovascular or all-cause mortality in CKD patients. It is an important issue for clinical workers to identify the CKD-MBD related control targets of serum calcium, phosphorus and PTH values, and a series of clinical guidelines and consensus have been provided in the past years. The target values for serum calcium and phosphorus are basically consistent, i.e. to achieve and maintain the values in the normal refer- ence ranges when possible. The calcium-phosphorus product is mainly affected by the phosphorus concentra- tion and has less significance. The target value for PTH is quite broad. The suggestion in KDIGO guidelines that intact PTH （iPTH） should be controlled in 2-9 times of the upper normal limit is widely mentioned but is controversial. However, a narrow range for iPTH cannot be defined in the published results so far. Clinically, the dynamic changes of CKD-MBD parameters are more valuable than a single value of one parameter.

关 键 词：慢性肾脏病 矿物质和骨异常 血钙 血磷 甲状旁腺激素 

分 类 号：R318.16[医药卫生—生物医学工程]