维持性血液透析合并继发性甲状旁腺功能亢进患者发生转移性钙化的影响因素分析  

Influencing factors of metastatic calcification in secondary hyperparathyroidism patients under maintenance hemodialysis

作　　者：孙长丽 董洋 王丽姣 赵心迪 张建荣[2] 张翥 邵凤民[1] SUN Chang-li;DONG Yang;WANG Li-jiao;ZHAO Xin-di;ZHANG Jian-rong;ZHANG Zhu;SHAO Feng-min(Department of Nephrology,Henan Provincial People’s Hospital,Fuwai Central China Cardiovascular Hospital,Henan Provincial Clinical Research Center for Kidney Disease,Henan Provincial Key Laboratory of Nephrology and Immunology,Fuwai Central China Cardiovascular Hospital of Zhengzhou University,Zhengzhou,Henan 450003,China;Department of Nephrology,the Third Medical Center of Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]河南省人民医院阜外华中心血管病医院肾内科河南省肾病临床医学研究中心河南省肾脏病免疫重点实验室郑州大学阜外华中心血管病医院,河南郑州450003 [2]解放军总医院第三医学中心肾脏病科,北京100039

出　　处：《中华实用诊断与治疗杂志》2022年第6期578-581,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家重点研发计划(2018YFC1311202);河南省重大科技专项(201300310700)。

摘　　要：目的观察维持性血液透析合并继发性甲状旁腺功能亢进患者转移性钙化的发生情况,探讨其发生转移性钙化的影响因素。方法行维持性血液透析治疗合并继发性甲状旁腺功能亢进患者70例,均行腹部侧位及全身骨骼X线片、超声心动图、甲状旁腺彩超及甲状旁腺核素扫描检测患者腹主动脉、心脏瓣膜及关节周围软组织钙化情况,根据是否发生转移性钙化将70例患者分为钙化组49例和非钙化组21例。比较2组年龄、透析龄、身高缩短长度、吸烟史、高血压、糖尿病、心血管病病史比率,透析前血清碱性磷酸酶、血钙、血磷、血肌酐及25-羟维生素D_(3)、白蛋白、高敏C反应蛋白、成纤维细胞生长因子23水平等临床资料;采用多因素logistic回归分析维持性血液透析合并继发性甲状旁腺功能亢进患者发生转移性钙化的影响因素。结果70例维持性血液透析合并继发性甲状旁腺功能亢进患者发生转移性钙化49例,发生率为70%,其中腹主动脉钙化19例(38.8%),心脏瓣膜钙化12例(24.5%),关节周围软组织钙化7例(14.3%),合并≥2个部位钙化11例(22.4%)。钙化组年龄[(53.63±9.63)岁]、透析龄[(14.00±4.23)年]、身高缩短长度[(10.04±6.23)cm]及血清甲状旁腺激素[(2466.22±874.64)ng/L]、血磷[(2.25±0.46)mmol/L]、钙磷乘积[(5.75±1.44)mmol^(2)/L^(2)]、碱性磷酸酶[(801.57±497.66)u/L]、成纤维细胞生长因子23[(1243.57±319.93)ng/L]、高敏C反应蛋白[(18.27±8.06)mg/L]水平均高于非钙化组[(47.81±9.46)岁、(7.57±2.71)年、(1.62±2.66)cm、(1390.74±270.88)ng/L、(1.88±0.46)mmol/L、(4.80±1.36)mmol^(2)/L^(2)、(321.28±208.36)u/L、(967.46±179.05)ng/L、(10.64±3.64)mg/L](P<0.05),25-羟维生素D_(3)[(12.44±6.13)g/L]水平低于非钙化组[(28.82±5.50)g/L](P<0.05)。透析龄≥11年(OR=2.792,95%CI:1.082~7.203,P=0.034)、血清甲状旁腺激素水平≥1859.2 ng/L(OR=1.004,95%CI:1.000~1.007,P=0.033)、成纤维细胞生长因�Objective To analyze the incidence of metastatic calcification in secondary hyperparathyroidism(SHPT)patients under maintenance hemodialysis,and to investigate the influencing factors of metastatic calcification.Methods Seventy SHPT patients under maintenance hemodialysis accepted abdominal lateral and whole body bone X-ray examination,echocardiography,parathyroid ultrasound and parathyroid nuclide scan to evaluate calcification of abdominal aorta,heart valve and periarticular soft tissue.Seventy patients were divided into calcification group(n=49)and non-calcification group(n=21).The age,dialysis age,shortened height,smoking,hypertension,diabetes,cardiovascular disease,and the levels of blood calcium,serum phosphorus,serum creatinine,serum alkaline phosphatase,25-hydroxy vitamin D_(3),albumin,high-sensitivity C-reactive protein,and fibroblast growth factor-23 were compared before dialysis between two groups.Multivariate logistic regression analysis was done to assess the influencing factors of metastatic calcification in SHPT patients under maintenance hemodialysis.Results In 70patients,49patients(70%)were found metastatic calcification,including 19patients(38.8%)with abdominal aortic calcification,12 patients(24.5%)with heart valve calcification,7patients(14.3%)with periarticular soft tissue calcification,and 11patients(22.4%)with two or more calcifications.The patients were older in calcification group[(53.63±9.63)years]than in non-calcification group[(47.81±9.46)years](P<0.05).The dialysis age was longer[(14.00±4.23)years],the shortened height was greater[(10.04±6.23)cm],and the levels of parathyroid hormone[(2466.22±874.64)ng/L],serum phosphorus[(2.25±0.46)mmol/L],calcium-phosphorus product[(5.75±1.44)mmol 2/L2],blood alkaline phosphatase[(801.57±497.66)u/L],fibroblast growth factor-23[(1243.57±319.93)ng/L]and high-sensitivity C-reactive protein[(18.27±8.06)mg/L]in calcification group were significantly higher than those in non-calcification group[(7.57±2.71)years,(1.62±2.66)cm,(1390.74±270.88)n

关 键 词：维持性血液透析 继发性甲状旁腺功能亢进 转移性钙化 

分 类 号：R692.5[医药卫生—泌尿科学] R582.1[医药卫生—外科学]