武汉地区血液透析患者矿物质-骨异常现状分析  

Analysis of mineral and bone disorders in maintenance hemodialysis patients in Wuhan area

作　　者：闵永龙 程力[1,2] 李红波 何家恒[1,2] 张燕敏 熊飞 MIN Yong-long;CHENG Li;LI Hong-bo;HE Jia-heng;ZHANG Yan-min;XIONG Fei(Department of Nephrology of the First Hospital of Wuhan City,Wuhan 430022,China;Blood Dialysis Quality Control Center of Wuhan City,Wuhan 430022,China)

机构地区：[1]武汉市第一医院肾病内科,武汉430022 [2]武汉市血液透析质量控制中心,武汉430022

出　　处：《中国血液净化》2020年第4期282-286,共5页Chinese Journal of Blood Purification

基　　金：武汉市医学科研项目(WG18C01);CKD-MBD青年研究基金项目(BCM01010)。

摘　　要：目的通过分析武汉地区维持性血液透析(maintenance hemodialysis,MHD)患者的矿物质-骨异常(mineral and bone disorder,MBD)现状,进一步提高相关指标的达标率。方法以武汉市血液透析质量控制平台中的MHD患者为研究对象,分析MBD指标(钙、磷、甲状旁腺激素)的达标率及相关影响因素。结果①共有50家透析单位4762例MHD患者纳入本研究,以K/DOQI(kidney disease outcomes quality initiative)为标准,钙(calcium,Ca)、磷(phosphorus,P)、甲状旁腺激素(parathyroid hormone,PTH)达标率分别为(46.5%、39.8%、24.6%),均低于DOPPS3、DOPPS4研究(χ^2=110.274、259.780、87.424,P均<0.001);②以武汉市质控标准,Ca、P、PTH达标率分别为(64.4%、39.8%、51.7%),年龄<60岁患者P的达标率低于≥60岁的患者(χ^2=14.149,P<0.001);血管通路为动静脉内瘘(arteriovenous fistula,AVF)的患者Ca、P的达标率高于非AVF患者(χ^2=6.555、27.800,P=0.010、<0.001);③血红蛋白(hemoglobin,Hb)达标的患者P、PTH达标率相比较更高(χ^2=21.211、31.106,P均<0.001),白蛋白(albumin,ALB)达标的患者Ca的达标率相对较高(χ^2=10.474,P=0.001),spKt/V达标的患者Ca、P的达标率相对较高(χ^2=5.164、14.785,P=0.023、<0.001);④多因素Logstic回归分析得出,Hb(OR=1.005,95%CI1.001~1.008,P=0.008)、 ALB(OR=1.087,95%CI 1.069~1.105,P<0.001)、 PTH(OR=1.001,95%CI1.001~1.001,P<0.001)是高磷的独立危险因素;AVF(OR=0.660,95%CI 0.577~0.756,P<0.001)、spKt/V(OR=0.792,95%CI 0.698~0.898,P<0.001)是高磷的独立保护因素。结论武汉地区矿物质-骨异常控制尚可,但与DOPPS还有一定差距,仍有进一步提高空间,血管通路方式、Hb、ALB、spKt/V与高磷血症密切相关,需进一步加强质量控制。Objective To analyze the mineral and bone disorder(MBD)in maintenance hemodialysis(MHD)patients in Wuhan area in order to improve the compliance rates of related indicators.Methods MHD patients registered in the Blood Dialysis Quality Control Center of Wuhan City were recruited as the study subjects.Their MBD indicators including serum phosphorus(P),calcium(Ca),intact parathyroid hormone(PTH)were collected,the compliance rates of these standards were compared with the results from Dialysis Outcomes and Practice Study(DOPPS),and factors associated with hyperphosphatemia were analyzed.Result①A total of 4,762 MHD patients from 50 dialysis centers were enrolled in this study.According to the standards in Kidney Disease Outcomes Quality Initiative(K/DOQI),the compliance rates of standard Ca,P and PTH were 46.5%,39.8%and 24.6%respectively,lower than the rates in DOPPS3 and DOPPS4(χ^2=110.274,466.402 and 70.512 respectively;P<0.001).②According to the quality control standards of Wuhan area,the compliance rates of standard Ca,P and PTH were 64.4%,39.8%and 51.7%respectively.The compliance rate of standard serum P was lower in patients<60 years old than those>60 years old(χ^2=14.149,P<0.001),and the compliance rates of standard Ca and P were higher in patients with arteriovenous fistula(AVF)than those without AVF(χ^2=6.555 and 27.800 respectively;P=0.010 and<0.001 respectively).③The compliance rates of standard P and PTH were higher in patients with the compliance of standard hemoglobin(Hb)(χ^2=21.211 and 31.106;P<0.001);the compliance rate of standard Ca was higher in patients with the compliance of standard albumin(ALB)(χ^2=10.474,P=0.001);the compliance rates of standard Ca and P were higher in patients with the compliance of standard spKt/V(χ^2=5.164 and 14.785 respectively;P=0.023 and<0.001 respectively).④Multivariate logistic regression analysis showed that Hb(OR=1.005,95%CI 1.00~1.008,P=0.008),ALB(OR=1.087,95%CI 1.069~1.105,P<0.001)and PTH(OR=1.001,95%CI 1.001~1.001,P<0.001)were the independent risk fa

关 键 词：维持性血液透析 矿物质-骨异常 现状分析 

分 类 号：R459.5[医药卫生—治疗学]