维持性血液透析合并难治性继发性甲状旁腺功能亢进患者腹主动脉钙化相关因素分析  

Abdominal aortic calcification in maintenance hemodialysis patients with refractory secondary hyperparathyroidism

作　　者：张蕊[1] 张念荣[2] 席秋萍 张学滨[3] 张凌[2] 李荣山[4] 

机构地区：[1]山西医科大学,太原030001 [2]中日友好医院肾内科 [3]中日友好医院放射科 [4]山西省人民医院肾内科

出　　处：《肾脏病与透析肾移植杂志》2017年第5期432-437,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：首都临床特色应用研究与成果推广(Z151100004015112)

摘　　要：目的:探讨维持性血液透析(MHD)合并难治性继发性甲状旁腺功能亢进(r SHPT)患者腹主动脉钙化(AAC)的相关因素。方法:选取2014年5月至2016年1月间于中日友好医院就诊拟行甲状旁腺切除术的r SHPT患者,记录患者一般情况,血清全段甲状旁腺激素(i PTH)、血清钙(Ca)、血清磷(P)及骨转化标志物等实验室指标,测量骨密度(BMD),根据AAC评分分为无钙化、轻度钙化、中重度钙化三组,比较三组之间的差异。结果:82例r SHPT患者纳入研究,年龄50.99±12.98岁,透析龄88.42±50.15月,男性40例占48.8%。AAC发生率为63.4%,其中腰椎L1~L4对应的四段血管壁均受累20例(24.4%)。男性AAC积分更高(P=0.016)。与无钙化组相比,发生钙化的两组年龄更大(P<0.001),透析龄更长(P<0.05);轻度及中重度钙化组的I型胶原羧基端肽(CTX)明显低于无钙化组(P<0.05)。多重线性回归分析发现:AAC与年龄(r=0.042,P<0.001)、血清磷(r=0.438,P=0.045)呈正相关,与CTX(r=-0.100,P=0.035)呈负相关。结论:MHD合并r SHPT患者AAC发生率高,高龄、男性、高血磷及CTX低是血管钙化的易感因素。Objective： To investigate correlation factors of abdominal aortic calcification（ AAC） in maintenance hemodialysis（ MHD） patients with refractory secondary hyperparathyroidism（ r SHPT）. Methodology： From May 2014 to January 2016, r SHPT patients without parathyroidectomy, in China-Japan Friendship Hospital were enrolled. The demographic data and biochemical data were collected,including intact parathyroid hormone（ i PTH）,calcium（ Ca）,phosphorus（ P）,Bone mineral density（ BMD） were measured using dual X-ray absorptiometry（ DXA）,AAC was evaluated using lateral X-ray plain films of abdomen. AAC severity was classified as absent（ AAC = 0）,mild（ 1≤ AAC score≤5）,and moderate to severe（ AAC score〉6）. Results： Eighty-two r SHPT patients were included,63.4% of them had AAC. Compared with absent calcification group,patients in the other two groups were elder（ P〈0. 001）,the dialysis time was longer（ P〈0. 05）,and C-telopeptide of type I collagen（ CTX） level in the absent calcification group was higher than the other groups（ P〈0. 05）. AAC was more severe in males（ P〈0. 05）. Multiple linear regression analysis shows that AAC was positively correlated with age（ r = 0. 042,P 〈 0. 001） and serum phosphorus（ r = 0. 438,P = 0. 045）,and negatively with CTX（ r =-0. 100,P = 0. 035）. Conclusion： 63. 4% of MHD patients with r SHPT presented with AAC, and AAC may correlate with age,male,serum phosphorus and CTX.

关 键 词：维持性血液透析 难治性继发性甲状旁腺功能亢进 腹主动脉钙化 Ⅰ型胶原羧基端肽 

分 类 号：R581.1[医药卫生—内分泌] R692[医药卫生—内科学]