中老年慢性肾脏病患者行透析治疗后矿物质与骨异常的发生情况及血磷异常的影响因素  

Occurrence of mineral and bone disorder and influencing factors of serum phosphorus disorder in middle-aged and elderly patients with chronic kidney disease after dialysis treatment

作　　者：何莉 黄燕林[1] 罗怡欣 侯璐蒙 赵萍 HE Li;HUANG Yan-lin;LUO Yi-xin;HOU Lu-meng;ZHAO Ping(Department of Nephrology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院肾内科,南宁市530021

出　　处：《广西医学》2020年第8期950-953,975,共5页Guangxi Medical Journal

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S2017030)。

摘　　要：目的了解中老年慢性肾脏病患者行透析治疗后矿物质与骨异常的发生情况及血磷异常的影响因素。方法纳入110例行持续非卧床腹膜透析(CAPD)治疗的患者(CAPD组)和104例行持续性血液透析(MHD)治疗的患者(MHD组)。检测两组患者血清磷、钙、全段甲状旁腺激素(iPTH)水平,并比较两组患者各项指标达标率以及慢性肾脏病矿物质与骨异常(CKD-MBD)发生情况。分析两组患者血清磷水平的影响因素。结果 CAPD组血清磷、校正钙、iPTH达标率和CKD-MBD发生率分别为41.8%(46/110)、44.5%(49/110)、35.5%(39/110)、92.7%(102/110),MHD组分别为48.1%(50/104)、48.1%(50/104)、29.8%(31/104)、93.3%(97/104),差异均无统计学意义(均P>0.05)。两组患者中,服用磷结合剂者的血清磷水平均低于未服用者(P<0.05);MHD组血清磷水平与iPTH呈正相关(P<0.05)。Logistic回归分析结果显示,是否服用磷结合剂是行CAPD与MHD治疗中老年患者血磷水平异常的独立影响因素(均P<0.05)。结论中老年慢性肾脏病患者行透析治疗后CKD-MBD患病率较高,血清钙、磷、iPTH达标率较低,而不服用磷结合剂是该类人群血磷异常的危险因素。Objective To understand the occurrence of mineral and bone disorder and the influencing factors of serum phosphorus disorder in middle-aged and elderly patients with chronic kidney disease after dialysis treatment. Methods A total of 110 patients receiving continuous ambulatory peritoneal dialysis(CAPD) treatment(CAPD group) and 104 patients receiving maintenance hemodialysis(MHD) treatment(MHD group) were enrolled. Serum phosphorus, calcium, and intact parathyroid hormone(iPTH) levels were detected in the both groups, and the compliance rates of all indices and incidence of chronic kidney disease-mineral and bone disorder(CKD-MBD) were analyzed in the two groups. The influencing factors of serum phosphorus level were analyzed in the two groups. Results The compliance rates of serum phosphorus, corrected calcium and iPTH and the incidence rate of CKD-MBD were 41.8%(46/110),44.5%(49/110), 35.5%(39/110) and 92.7%(102/110) in the CAPD group, respectively, which were 48.1%(50/104), 48.1%(50/104),29.8%(31/104) and 93.3%(97/104) in the MHD group, respectively, and the indices described above showed no statistically significant difference between the two groups(all P>0.05). Among patients in the two groups, those with phosphorus binder administration had a lower serum phosphorus level than those without phosphorus binder administration(P<0.05);serum phosphorus level positively correlated with iPTH in the MHD group(P<0.05). The results of Logistic regression analysis showed that oral administration of phosphorous binder was an independent influencing factor of abnormal serum phosphorous level in middle-aged and elderly patients with CAPD and MHD treatment(all P<0.05). Conclusion Middle-aged and elderly patients have a higher prevalence rate of CKD-MBD and lower compliance rates of serum calcium, phosphorus and iPTH after dialysis, and phosphorus binder-na?ve treatment is a risk factor for serum phosphorus disorder in this population.

关 键 词：慢性肾脏病 腹膜透析 血液透析 慢性肾脏病矿物质与骨异常 中老年人 血磷异常 影响因素 

分 类 号：R692.5[医药卫生—泌尿科学]