CAJ | 학술논문

目的探讨血液透析患者钙磷代谢紊乱和甲状旁腺功能异常的情况及其可能的影响因素.方法选择2009年1月至2010年12月在上海市静安区中心医院血液透析中心行常规血液透析3个月以上病情稳定的慢性尿毒症患者198例,所有患者于透析前空腹抽血,检测血红蛋白、血清肌酐、尿素氮、钙、磷、全段甲状旁腺激素(iPTH)、超敏C-反应蛋白(hs-CRP)、白蛋白(Alb)等,同时测定透析后血清尿素氮浓度,记录超滤量、透析后体重和透析时间,根据公式计算血清白蛋白校正钙(Ac-Ca)和尿素清除指数(Kt/V).参照美国肾脏病基金会慢性透析患者骨代谢和疾病临床实践指南的要求,统计钙磷代谢和甲状旁腺功能水平的达标情况,根据患者血清iPTH浓度分为达标组(150 ～ 300 ng/L)、低于达标组(＜ 150 ng/L)和高于达标组(＞300 ng/L),分析其可能的影响因素.结果198例血液透析患者校正的血钙达标110例(55.6％),血磷达标118例(59.6％),钙磷乘积达标143例(72.3％),血iPTH达标39例(19.7％),四项均达标28例(14.1％).然而,血iPTH平均浓度为(133.65±126.37)ng/L,低于标准132例(66.7％),高于标准27例(13.6％).随着血液透析患者年龄的增长,其iPTH平均浓度逐渐下降(r=-0.258,P＜0.01).3组比较,低于达标组患者的年龄最大,平均血hs-CRP最高,平均血磷和Alb浓度最低,差异均有统计学意义(P均＜0.05).3组的性别构成、透析时间、糖尿病的发生率、血压、血红蛋白、尿素氮、肌酐、校正钙和Kt/V等指标差异无统计学意义.结论维持性血液透析患者普遍存在钙磷代谢和甲状旁腺功能紊乱的问题,应重视甲状旁腺功能低下的现象,其发生可能与老年、营养不良、潜在感染等因素有关,有待进一步研究.
목적 탐토혈액투석환자개린대사문란화갑상방선공능이상적정황급기가능적영향인소.방법 선택2009년1월지2010년12월재상해시정안구중심의원혈액투석중심행상규혈액투석3개월이상병정은정적만성뇨독증환자198례,소유환자우투석전공복추혈,검측혈홍단백、혈청기항、뇨소담、개、린、전단갑상방선격소(iPTH)、초민C-반응단백(hs-CRP)、백단백(Alb)등,동시측정투석후혈청뇨소담농도,기록초려량、투석후체중화투석시간,근거공식계산혈청백단백교정개(Ac-Ca)화뇨소청제지수(Kt/V).삼조미국신장병기금회만성투석환자골대사화질병림상실천지남적요구,통계개린대사화갑상방선공능수평적체표정황,근거환자혈청iPTH농도분위체표조(150 ～ 300 ng/L)、저우체표조(＜ 150 ng/L)화고우체표조(＞300 ng/L),분석기가능적영향인소.결과198례혈액투석환자교정적혈개체표110례(55.6％),혈린체표118례(59.6％),개린승적체표143례(72.3％),혈iPTH체표39례(19.7％),사항균체표28례(14.1％).연이,혈iPTH평균농도위(133.65±126.37)ng/L,저우표준132례(66.7％),고우표준27례(13.6％).수착혈액투석환자년령적증장,기iPTH평균농도축점하강(r=-0.258,P＜0.01).3조비교,저우체표조환자적년령최대,평균혈hs-CRP최고,평균혈린화Alb농도최저,차이균유통계학의의(P균＜0.05).3조적성별구성、투석시간、당뇨병적발생솔、혈압、혈홍단백、뇨소담、기항、교정개화Kt/V등지표차이무통계학의의.결론 유지성혈액투석환자보편존재개린대사화갑상방선공능문란적문제,응중시갑상방선공능저하적현상,기발생가능여노년、영양불량、잠재감염등인소유관,유대진일보연구.
Objective To investigate disorders in calcium and phosphorus metabolism and abnormity in parathyroid function and their related factors in maintenance hemodialysis(MHD)patients.Methods We collected serum Hb,SCr,BUN,calcium,phosphorus,iPTH,high sensitivity C-reactive protein(hs-CRP),albumin and calculated albumin-corrected Ca and Kt/V from 198 patients with MHD in Jing'an District Central Hospital,Shanghai from Jan.2009 to Dec.2010.The calcium and phosphorus metabolism and parathyroid function were evaluated according to the guidelines of bone metabolism and controlling of bone disease in Kidney Disease Outcome Quality Initiative(KDOQI)recommended by National Kidney Foundation of the United States.198 patients were classified into the standard group(150-300 ng/L),lower than the standard group(＜150 ng/L)and higher than the standard group(＞ 300 ng/L)according to serum iPTH levels.Results In the 198 cases,110 cases were normal in serum Ac-Ca(55.6％); 118 cases were normal in serum phosphorus (59.6％); 143 cases were normal in Ca × P(72.3％); 39 cases were normal in iPTH(19.7％).All four items up to the standard were 28 cases(14.1％)among 198 cases.However,132(66.7％)patients showed lower than 150 ng/L in serum iPTH.The average serum iPTH gradually decreased with age.The senior patients demonstrated the highest average serum Hs-CRP,the lowest average serum phosphorus and the lowest albumin.There were no statistical significance in sex,hemodialysis duration,diabetes,blood pressure,Hb,Bun,SCr,Ac-Ca and Kt/V among three groups.Conclusion The disorders in calcium and phosphorus metabolism and abnormity in parathyroid function is common in the MHD patients.We should pay attention to hypofunction of parathyroid gland in the patients with MHD,which may be related to aging,malnutrition and potential infection.These findings need further investigation.