腹膜透析与血液透析患者钙磷代谢的比较及影响因素分析  

Comparison of calcium-phosphorus metabolism between peritoneal dialysis and hemodialysis patients and analysis of influencing factors

作　　者：程力[1] 闵永龙 万胜[1] 何达[1] 陈芳[1] 张燕敏[1] 熊飞[1] CHENG Li;MIN Yong-long;WAN Sheng;HE Da;CHEN Fang;ZHANG Yan-min;XIONG Fei(Department of Nephrology,Wuhan NO.1 Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院肾病内科,武汉430022

出　　处：《临床肾脏病杂志》2020年第11期886-890,共5页Journal Of Clinical Nephrology

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：目的比较腹膜透析(peritoneal dialysis,PD)与血液透析(hemodialysis,HD)对患者钙磷代谢的影响,并分析相关影响因素,为临床治疗提供治疗依据和改进措施。方法收集2018年10月1日至2019年10月1日在武汉市第一医院行维持性PD与HD患者的临床资料和基线数据,比较PD和HD患者在透析3、6、12个月后的血钙、血磷及全段甲状旁腺素等指标的差异,并分析相关影响因素。结果(1)HD组血磷的水平在透析3个月(t=-4.044,P<0.001)、6个月(t=-5.886,P<0.001)、12个月(t=-7.808,P<0.001)均较PD组高;血钙水平在6个月(t=6.521,P<0.001)、12个月(t=6.841,P<0.001)较PD组低;钙磷乘积水平在透析12个月(t=-2.080,P=0.038)较PD组高。(2)透析12个月后,PD组患者血磷(χ^2=4.329,P=0.037)、血钙(χ^2=5.587,P=0.018)、钙磷乘积(χ^2=5.750,P=0.016)的达标率较HD组明显偏高。(3)对可能影响透析患者钙磷代谢的因素进行多元线性回归分析得出,透析方式(B=-0.287,P=0.005)、年龄(B=-0.010,P=0.005)、透析时间(B=-0.010,P=0.027)、血钠(B=-0.026,P=0.033)是血磷水平的独立影响因素,且呈负相关。结论相比于HD,PD能够更好地控制血磷、血钙水平,透析方式、患者年龄较低、透析时间短、血钠较低是血磷升高的影响因素。Objective To compare the effects of peritoneal dialysis(PD)and hemodialysis(HD)on calcium-phosphorous metabolism in uremic patients,and to analyze the related influencing factors so as to provide basis and improvement measures for the clinical treatment.Methods The clinical data of PD and HD patients undergoing maintenance PD and HD in our hospital from October 1 st,2018 to October 1 st,2019 were collected and analyzed retrospectively.The serum calcium,phosphorus and intact parathyroid hormone were collected and compared between the patients with PD and HD at 0,3,6 and 12 months of dialysis.Multivariate linear regression was used to analyze the related influencing factors of calcium-phosphorus metabolism abnormality.Results(1)The levels of serum phosphorus at 3(t=-4.044,P<0.001),6(t=-5.886,P<0.001)and 12(t=-7.808,P<0.001)months of dialysis in the HD group were all higher than those in the PD group.The levels of serum calcium at 6(t=6.521,P<0.001)and 12(t=6.841,P<0.001)moths of dialysis were lower than those in the PD group,and the level of calcium-phosphorus product at 12 months(t=-2.080,P=0.038)was higher than that in the PD group.(2).After 12 months of dialysis,the compliance rates of serum phosphorus(χ^2=4.329,P=0.037),serum calcium(χ^2=5.587,P=0.018)and calcium-phosphorus product(χ^2=5.750,P=0.016)in the PD group were significantly higher than those in the HD group.(3)The multivariate linear regression analysis of the factors that may influence the calcium-phosphorous metabolism in dialysis patients showed that the dialysis modality(B=-0.287,P=0.005),age(B=-0.010,P=0.005),dialysis duration(B=-0.010,P=0.027),and sodium(Na)(B=-0.026,P=0.033)were the independent influencing factors of the level of serum phosphorus,with negative correlation.Conclusions Compared with HD,the levels of serum phosphorus and calcium can be controlled better by PD.Low age,low dialysis age and low sodium were independent influencing factors of increase blood phosphorus level.

关 键 词：血液透析 腹膜透析 钙磷代谢 影响因素 

分 类 号：R692.5[医药卫生—泌尿科学]