123例维持性血液透析患者矿物质及骨代谢水平的调查分析  

Investigation on mineral and bone abnormalities in 123 maintenance hemodialysis patients

作　　者：兰天鹰 叶朝阳 姚东升[1] 吴锋[1] 王骆冰[1] 王琛[1] LAN Tian-ying;YE Chao-yang;YAO Dong-sheng;WU Feng;WANG Luo-bin;WANG Chen(Department of Nephrology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院肾病科&肝肾疾病病证教育部重点实验室(上海中医药大学)&上海市中医临床重点实验室(14DZ2273200)

出　　处：《临床肾脏病杂志》2018年第8期488-492,共5页Journal Of Clinical Nephrology

基　　金：国家自然基金资助项目(No.81573946);上海市科委科技支撑计划专项(No.16401931700)

摘　　要：目的调查分析上海中医药大学附属曙光医院肾病科透析中心维持性血液透析(MHD)患者矿物质和骨代谢水平,进行相关因素分析并探讨调控方法。方法采用横断面研究方法调查123例MHD患者矿物质和骨代谢指标达标情况,分析各指标与调查对象年龄、性别、透析时间、血红蛋白、尿素氮、碱性磷酸酶等因素之间的相关性。结果 123例MHD患者68.29%血钙达标,28.46%血磷达标,56.10%全段甲状旁腺素(i PTH)达标,所有指标全部达标者仅13例,达标率为10.57%。骨代谢紊乱与年龄、肾功能、血β2-微球蛋白、高血压、铁蛋白、碱性磷酸酶、Kt/V有相关性;高碱性磷酸酶与高水平i PTH相关,低水平i PTH与糖尿病相关。结论 MHD患者矿物质和骨代谢水平紊乱的发生率较高,本中心调查结果与指南的要求仍然存在较大的差距,患者的年龄、透析时间、高血压、血红蛋白、i PTH、血磷、钙磷结合剂的使用、活性维生素D的使用等是影响MHD患者矿物质和骨代谢水平的主要相关因素,仍然需要进一步加强防治。Objective To investigate and analyze the controlling situation of mineral and bone disorder（MBD） in maintenance hemodialysis patients, analyze their related factors, and discuss control methods. Methods We investigated MBD in 123 maintenance hemodialysis patients and compared these data with the guidelines. We also analyzed age,gender,years for dialysis,hemoglobin（Hb）,renal function,alkaline phosphatase（ALP）, blood pressure and diabetic mellitus in these patients. Results In the 123 cases,Serum Ca in 84（68. 29%） cases, phosphate in 35（28. 46%） cases,and iPTH in 69（56. 10%） cases met the requirements of the guidelines.However,normal values of the above 3 parameters recommended by KDIGO were only found in13（10.57%） cases. MBD was correlated with age, renal function, β2-MG, blood pressure, ferritin, ALP, Kt/V. However,gender,years for dialysis,BMI and diabetic mellitus were not correlated with MBD. In addition, higher level of ALP was correlated with higher iPTH level. But hemodialysis patients with diabetic mellitus in lower iPTH level group were more than other groups. Conclusions CKD-MBD has a high incidence in MHD. There was still a long distance between the biochemical indicator of our hemodialysis center and the guideline. The age,years for dialysis,blood pressure,Hb,phosphate,iPTH,the use of calcium phosphate binder, and the use of active vitamin D were the main factors which influence the MBD in MHDs. A better prevention and control method still needs to implement in our hemodialysis center.

关 键 词：维持性血液透析 骨代谢紊乱 甲状旁腺素 

分 类 号：R692.5[医药卫生—泌尿科学]