血清Ca、P、PTH、HbA1c表达水平与糖尿病肾病血透患者预后的相关性探讨  

Correlation Between Serum Ca,P,PTH,Hba1c Expression Levels and Predictive Value in Hemodialysis Patients with Diabetes Kidney Disease

作　　者：许丽君 方超兰 陈幼清 徐淑端[1] XU Lijun;FANG Chaolan;CHEN Youqing;XU Shuduan(Department of Laboratory,910th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China,Quanzhou 362000,Fujian,China)

机构地区：[1]中国人民解放军联勤保障部队第910医院检验科,福建泉州362000

出　　处：《中外医疗》2024年第23期59-62,66,共5页China & Foreign Medical Treatment

摘　　要：目的探讨糖尿病肾病患者接受血液透析治疗后预后情况与血清钙(calcium,Ca)、磷(phosphorus,P)、甲状旁腺激素(parathyroid hormone,PTH)、糖化血红蛋白(glycated hemoglobin,HbA1c)水平的预测价值。方法回顾性选取2021年1月—2023年12月中国人民解放军联勤保障部队第910医院收治90例糖尿病肾病患者的临床资料,患者均接受血液透析治疗,根据患者预后情况分作对照组(预后良好,78例)与观察组(预后不良,12例)。比较观察两组血清Ca、P、PTH与HbAlc水平,通过Logistic回归分析患者预后影响因素,采用接受者操作特征(receiver operating characteristic,ROC)曲线分析各指标单一及联合应用对患者预后的预测价值。结果观察组P、PTH水平低于对照组,HbA1c水平高于对照组,差异有统计学意义(P均<0.05)。Logistic回归分析结果显示,P(OR=2.556,95%CI为1.319~4.953)、PTH(OR=3.035,95%CI为1.811~5.086)与HbA1c(OR=2.974,95%CI为1.552~5.699)是糖尿病肾病血液透析患者预后的独立危险因素(P均<0.05)。ROC曲线分析显示,P、PTH与HbA1c对糖尿病肾病血透患者的预后均具有预测价值(AUC=0.714、0.805、0.753,P均<0.05),且联合检测的曲线下面积与约登指数最大(AUC=0.896,YI=0.865)。结论血清P、PTH与HbA1c是糖尿病肾病血透患者预后的独立危险因素,对患者预后具有预测性,联合应用可以进一步提高预测效能,可以为临床评估患者预后提供有价值的实验室依据。Objective To investigate the predictive value of serum calcium(Ca),phosphorus(P),parathyroid hormone(PTH)and glycated hemoglobin(HbA1c)levels in patients with diabetic kidney disease after hemodialysis.Methods From January 2021 to December 2023,The clinical data of 90 patients with diabetic kidney disease admitted to the 910th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China were retrospectively se-lected.All patients received hemodialysis treatment.According to the prognosis of patients,they were divided into control group(good prognosis,78 cases)and observation group(poor prognosis,12 cases).The levels of serum Ca,P,PTH and HbAlc were compared between the two groups.Logistic regression was used to analyze the prognostic factors of patients.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of single and combined application of each index on the prognosis of patients.Results The level of P and PTH in observation group were lower than those in the control group,and the level of HbA1c was higher than that in the control group,the differ-ences were statistically significant(all P<0.05).The logistic regression analysis showed that P(OR=2.556,95%CI 1.319~4.953),PTH(OR=3.035,95%CI 1.811~5.086),and HbA1c(OR=2.974,95%CI 1.552~5.699)were indepen-dent risk factors for the prognosis of diabetic nephropathy patients undergoing hemodialysis(all P<0.05).ROC curve analysis showed that P,PTH and HbAlc had predictive value for the prognosis of hemodialysis patients with diabetic nephropathy(AUC=0.714,0.805,0.753,all P<0.05),and the area under the curve and Youden index of combined test were the largest(AUC=0.896,YI=0.865).Conclusion Serum P,PTH and HbA1c are independent risk factors for the prognosis of hemodialysis patients with diabetes kidney disease,and can predict the prognosis of patients.Combined application can further improve the prediction efficiency,and can provide valuable laboratory basis for clinical evaluation of patient prognosis.

关 键 词：血清糖化血红蛋白 糖尿病肾病 血液透析 预后相关性 

分 类 号：R587.2[医药卫生—内分泌]