维持性血液透析患者血清维生素C水平与其骨-矿物质代谢关系初探  

Exploring the relationship between the serum vitamin C concentration and parameter values reflecting the Mineral and Bone Disorder in hemodialysis patients

作　　者：黄雯[1] 蔡笑[1] 张国娟[1] 段晓峰 赵慧颖[1] 张梅[1] 姜丽萍[1] 郑洁[1] 

机构地区：[1]首都医科大学附属北京同仁医院肾内科,北京100730 [2]北京普仁医院肾内科,北京100730

出　　处：《中国血液净化》2017年第8期537-541,共5页Chinese Journal of Blood Purification

摘　　要：目的观察维持性血液透析患者(maintenance hemodialysis,MHD)血清维生素C(vitamin C,VC)水平,对血清VC水平与慢性肾脏病-骨矿物质代谢异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)的关系进行初步探讨。方法采取自身前后对照方法。入选MHD患者92例,检测患者透析前基础血清VC值,以及血清全段甲状旁腺激素(intact Parathyroid hormone,i PTH)、碱性磷酸酶(alkaline Phosphatase,ALP)、钙(calcium,Ca)、磷(phosphate,P)、及钙磷乘积。根据患者血清VC水平,将患者分为VC正常组(VC≥4mg/L,非干预组)及VC缺乏组(VC<4mg/L,干预组)。干预组于每次血液透析后给予VC注射液300mg静注,共计36次。观察3个月。于观察期结束时再次测定患者的血清VC值、血i PTH、ALP、Ca、P及钙磷乘积。采用SPSS19.0软件进行统计分析。结果 1、MHD患者VC缺乏达78.3%。VC正常组和VC缺乏组的基础血清VC均值有明显差异[5.644(2.200)比1.312(1.940)mg/L,Z=-6.895,P<0.001];且两组的血清i PTH值[99.00(230.72)比206.30(315.10)pg/ml,Z=-1.049,P=0.029]和ALP值[82.00(42.50)比123.00(234.00)U/L,Z=-2.367,P=0.018]亦有明显差异。2、3个月观察期后:(1)血清VC水平:非干预组患者较前降低,但无明显差异[5.64(4.29,6.49)比5.11(3.94,6,15)Z=-1.904,P=0.057]。干预组患者较前明显增高[1.31(0.80,2.02)比4.59(2.46,5.70),Z=-3.320,P<0.001],差异有统计学意义。(2)血清MBD指标:非干预组患者血清i PTH、ALP、P、钙磷乘积较前轻度升高,但差异均无统计学意义。干预组患者血清i PTH[206.30(133.40,428.50)比154.00(76.50,388.00)pg/m L,Z=-2.207,P<0.001]和血清ALP[123.00(78.00,312.00)比95.00(60.00,140.00)U/L,Z=-3.749,P=0.011]明显降低,差异有统计学意义;血清Ca、P、钙磷乘积较前轻度降低,但差异无统计学意义。(3)Pearson/Spearman相关系数及线性回归方程结果显示,MHD患者血清VC水平与ALP水平之间存在负相关关系(B=-8.538,P=0.014)。结论 MHD患者VC缺乏现象普遍存在。常Purpose To explore the relationship between the serum concentration of vitamin C （VC） and parameter values reflecting the Mineral and Bone Disorder （MBD） in Maintenance hemodialysis （MHD） pa- tients. Method This study employs a pre-post self-comparison design. 92 patients were selected and divided into two groups based on the level of the serum VC concentration at the beginning of the study： a normal-VC group （VC〉=4mg/L, the control group） and a deflcient-VC group （VC〈4mg/L, the intervention group）. At the same times, all patients＇ intact Parathyroid hormone （iPTH）, Alkaline Phosphatase （ALP）, Calcium （Ca）, Phosphate （P）, and Ca×P were examined and recorded at the beginning of the study. During the study, the in- tervention group was given an injection of 300mg vitamin C at the end of each dialysis, while the normal group got no treatment. The patients were monitored for 3 months and then examined again on the serum con- centration of VC, iPTH, ALP, Ca, P and Ca× P at the end of the observation period. The data was analyzed with SPSS 19.0. Results （1）VC deficiency was common in the MHD patients （78.3%）. There was a signifi- cant difference in the base serum vitamin C level between the normal-VC group and the deficient-VC group [5.644（2.200） vs.1.312（1.940） mg/L, Z=-6.895, P〈0.001], as well as in the serum iPTH [99.00（230.72）vs. 206.30（315.10）pg/ml, Z=- 1.049, P=0.029] and ALP [82.00（42.50） vs. 123.00（234.00）U/L, Z=-2.367, P=0.018]. （2）After the three-month observation period： （1） The serum VC concentration of the control group was reduced than before, but the difference was not statistically significant （5.64（4.29, 6.49） vs. 5.11 （3.94, 6,15）P=0.057）. The VC concentration of the intervention group was statistically significantly increased （mg/L , （1.31（0.80, 2.02） vs. 4.59（2.46, 5.70）, P〈0.001）. ~）The serum MBD indicators： the serum iPTH, ALP, P, and Ca×P of the patients in the control group

关 键 词：血液透析 维生素C(VC) 骨矿物质代谢异常(MBD) 

分 类 号：R318.16[医药卫生—生物医学工程]