中青年腹膜透析患者糖脂代谢与钙磷代谢的相关性  

Relationship between glucose and lipid metabolism and calcium and phosphorus metabolism in young and middle-aged peritoneal dialysis patients

作　　者：韩天曌 龚蓉[1] 皮婧静[1] 全大勇[1] 肖淑心 HAN Tianzhao;GONG Rong;PI Jingjing;QUAN Dayong;XIAO Shuxin(Department of Nephrology, Chengdu Third People's Hospital, Southwest Jiaotong University School of Clinical Medicine, Chengdu 610031, China)

机构地区：[1]成都市第三人民医院·西南交通大学临床医学院肾脏科,四川成都610031

出　　处：《西部医学》2022年第2期255-259,共5页Medical Journal of West China

基　　金：百特中国肾科研究基金(CHN-RENAL-IIS-2015-016)。

摘　　要：目的探讨中青年腹膜透析(PD)患者糖脂代谢与钙磷代谢紊乱的相关性。方法选取2014年1月~2020年8月期间在本院腹膜透析单元治疗随访的172例腹膜透析患者行回顾性分析,分为青年组(82例)和中年组(90例),比较两组糖化血红蛋白(HbA_(1c))、空腹血糖、餐后2小时血糖、空腹血糖受损(IFG)检出率、血钙、血磷、血清全段甲状旁腺激素(iPTH)、成纤维细胞生长因子(FGF23)、残肾功能(RRF)、血脂等指标,采用Pearson、Spearman及逐步回归分析HbA_(1c)、iPTH、FGF23的影响因素;根据是否患有糖尿病分为非糖尿病组(134例)和糖尿病组(38例),比较两组HbA_(1c)、血钙、血磷等指标。结果中年组HbA_(1c)、空腹血糖、IFG检出率较青年组更高(P<0.05),血钙、血磷、iPTH较青年组更低(P<0.05),两组甘油三酯、胆固醇、FGF23比较差异无统计学意义(P>0.05),但甘油三酯、FGF23中青年组均高于参考值水平(P>0.05)。Pearson相关分析HbA_(1c)与logiPTH、logFGF23呈负相关(P<0.05),与甘油三酯呈正相关(P<0.05),Spearman相关分析log iPTH与透析龄、logFGF23、血钙、血磷呈正相关(P<0.05),与HbA_(1c)、RRF呈负相关(P<0.05)。Spearman相关分析log FGF23与透析龄、log iPTH、血钙、血磷呈正相关(P<0.05),与HbA_(1c)、RRF呈负相关(P<0.05),逐步回归分析HbA_(1c)与log iPTH和甘油三酯的相关关系分别为独立负相关、独立正相关(P<0.01),与logFGF23不独立相关(P=0.902);糖尿病组HbA_(1c)、甘油三酯、胆固醇、FGF23较非糖尿病组更高(P<0.05),血钙、血磷、iPTH较非糖尿病组更低(P<0.05)。结论中青年PD患者易出现糖脂代谢与钙磷代谢紊乱,中年患者更严重且易出现低iPTH血症,而PD患者血糖控制水平与iPTH分泌具有相关性,进而影响FGF23水平。并且糖尿病患者易出现脂代谢紊乱,中青年PD患者糖代谢与iPTH应一体化诊治。Objective To analyze the correlation of glucose and lipid,calcium and phosphorus metabolism disorders in young and middle-aged peritoneal dialysis patients.Methods A retrospective analysis was performed on 172 peritoneal dialysis patients who were treated and followed up in the peritoneal dialysis unit of our hospital from January 2014 to August 2020.The patients were divided into young-aged group and middle-aged group.The number of the youth group is 82,and the number of the middle-aged group is 90.Glycosylated hemoglobin A1C(HbA1c),fasting plasma glucose,2 hours postprandial blood glucose,blood calcium and phosphorus,intact parathyroid hormone(iPTH),blood lipid and residual renal function were analyzed.Pearson and multiple stepwise regressions were used to analyze the correlation between HbA1c and metabolic related indexes.They were divided into non-diabetic group(n=134)and diabetic group(n=38)according to whether they had diabetes.The indexes of HbA1c,blood calcium,blood phosphorus and other indicators were compared between the two groups.Results The levels of HbA1c,fasting blood glucose,2 hours postprandial blood glucose and IFG in the middle-aged group were higher than that of young-aged group(P<0.05).The value of iPTH,blood calcium and phosphorus was lower in middle-aged group compared with young-aged group(P<0.05).There was no difference in FGF23 and blood lipid index between the two groups(P>0.05),but they were all higher than the normal reference level.Pearson correlation analysis showed that HbA1c was negatively correlated with logiPTH and logFGF23(P<0.05),and positively correlated with triglycerides(P<0.05).Spearman correlation analysis showed that log iPTH was positively correlated with dialysis age,logFGF23,serum calcium and phosphorus(P<0.05),and negatively correlated with HbA1c and RRF(P<0.05).Spearman correlation analysis showed that log FGF23 was positively correlated with dialysis age,log iPTH,serum calcium and phosphorus(P<0.05),and HbA1c and RRF(P<0.05).Stepwise regression analysis showed that

关 键 词：中青年 腹膜透析 糖化血红蛋白 血清全段甲状旁腺激素 成纤维细胞生长因子 

分 类 号：R459.5[医药卫生—治疗学]