中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
18期
4-6
,共3页
肾功能不全,慢性%骨矿盐代谢%骨密度
腎功能不全,慢性%骨礦鹽代謝%骨密度
신공능불전,만성%골광염대사%골밀도
Kidney failure,chronic%Bone mineral salt metabolism%Bone density
目的 探讨慢性肾脏病(CKD)不同病期患者的骨密度及骨矿盐代谢指标的变化情况.方法 非透析CKD患者345例,根据2002年美国肾脏病基金会(NKF)K/DOQI专家组CKD分期以及我国慢性肾衰竭分期方法按血清肌酐(SCr)、肾小球滤过率(GFR)水平分为CKD 1 ～5期,CKD 1期75例,CKD 2期65例,CKD 3期65例,CKD4期65例,CKD 5期75例,抽取受试者静脉血,分离血清,用离子选择电极法测定血钙、磷和SCr;用苦味酸法测定血尿素氮(BUN)；用化学发光法测定血全段甲状旁腺激素(iPTH)及1,25羟基维生素D3[1,25(OH)2 VitD3].结果 CKD患者随着肾功能下降,血iPTH、磷水平逐渐升高,以CKD4期和CKD 5期升高明显,与CKD1期比较差异有统计学意义[(289.6578±187.7945)、(482.0667±232.2065)μg/L比(77.8431±52.9760) μg/L,(1.6938±0.1960)、(2.6034±0.5986) mmol/L比(1.3833±0.4068) mmol/L,P＜ 0.05]；血钙、1,25(OH)2VitD3水平逐渐下降,以CKD 4期和CKD5期下降明显,与CKD 1期比较差异有统计学意义[(1.9185±0.4633)、(1.8293±0.3075) mmol/L比(2.0893±0.2245) mmol/L,(10.0892±0.2638)、(7.6058±0.4356) ng/L比(18.0036±0.3218) ng/L,P＜ 0.05].随着肾功能减退,骨质疏松的比例也逐渐升高,且以CKD5期最显著,与CKD 1期和CKD 2期比较差异有统计学意义[60.00％(45/75)比20.00％(15/75)、23.08％(15/65),P＜0.05].结论 随着肾功能减退,血iPT-H、磷水平逐渐升高,血钙、1,25 (OH)2 VitD3水平以及骨密度逐渐下降,尤其以CKD4期和CKD5期最明显.
目的 探討慢性腎髒病(CKD)不同病期患者的骨密度及骨礦鹽代謝指標的變化情況.方法 非透析CKD患者345例,根據2002年美國腎髒病基金會(NKF)K/DOQI專傢組CKD分期以及我國慢性腎衰竭分期方法按血清肌酐(SCr)、腎小毬濾過率(GFR)水平分為CKD 1 ～5期,CKD 1期75例,CKD 2期65例,CKD 3期65例,CKD4期65例,CKD 5期75例,抽取受試者靜脈血,分離血清,用離子選擇電極法測定血鈣、燐和SCr;用苦味痠法測定血尿素氮(BUN)；用化學髮光法測定血全段甲狀徬腺激素(iPTH)及1,25羥基維生素D3[1,25(OH)2 VitD3].結果 CKD患者隨著腎功能下降,血iPTH、燐水平逐漸升高,以CKD4期和CKD 5期升高明顯,與CKD1期比較差異有統計學意義[(289.6578±187.7945)、(482.0667±232.2065)μg/L比(77.8431±52.9760) μg/L,(1.6938±0.1960)、(2.6034±0.5986) mmol/L比(1.3833±0.4068) mmol/L,P＜ 0.05]；血鈣、1,25(OH)2VitD3水平逐漸下降,以CKD 4期和CKD5期下降明顯,與CKD 1期比較差異有統計學意義[(1.9185±0.4633)、(1.8293±0.3075) mmol/L比(2.0893±0.2245) mmol/L,(10.0892±0.2638)、(7.6058±0.4356) ng/L比(18.0036±0.3218) ng/L,P＜ 0.05].隨著腎功能減退,骨質疏鬆的比例也逐漸升高,且以CKD5期最顯著,與CKD 1期和CKD 2期比較差異有統計學意義[60.00％(45/75)比20.00％(15/75)、23.08％(15/65),P＜0.05].結論 隨著腎功能減退,血iPT-H、燐水平逐漸升高,血鈣、1,25 (OH)2 VitD3水平以及骨密度逐漸下降,尤其以CKD4期和CKD5期最明顯.
목적 탐토만성신장병(CKD)불동병기환자적골밀도급골광염대사지표적변화정황.방법 비투석CKD환자345례,근거2002년미국신장병기금회(NKF)K/DOQI전가조CKD분기이급아국만성신쇠갈분기방법안혈청기항(SCr)、신소구려과솔(GFR)수평분위CKD 1 ～5기,CKD 1기75례,CKD 2기65례,CKD 3기65례,CKD4기65례,CKD 5기75례,추취수시자정맥혈,분리혈청,용리자선택전겁법측정혈개、린화SCr;용고미산법측정혈뇨소담(BUN)；용화학발광법측정혈전단갑상방선격소(iPTH)급1,25간기유생소D3[1,25(OH)2 VitD3].결과 CKD환자수착신공능하강,혈iPTH、린수평축점승고,이CKD4기화CKD 5기승고명현,여CKD1기비교차이유통계학의의[(289.6578±187.7945)、(482.0667±232.2065)μg/L비(77.8431±52.9760) μg/L,(1.6938±0.1960)、(2.6034±0.5986) mmol/L비(1.3833±0.4068) mmol/L,P＜ 0.05]；혈개、1,25(OH)2VitD3수평축점하강,이CKD 4기화CKD5기하강명현,여CKD 1기비교차이유통계학의의[(1.9185±0.4633)、(1.8293±0.3075) mmol/L비(2.0893±0.2245) mmol/L,(10.0892±0.2638)、(7.6058±0.4356) ng/L비(18.0036±0.3218) ng/L,P＜ 0.05].수착신공능감퇴,골질소송적비례야축점승고,차이CKD5기최현저,여CKD 1기화CKD 2기비교차이유통계학의의[60.00％(45/75)비20.00％(15/75)、23.08％(15/65),P＜0.05].결론 수착신공능감퇴,혈iPT-H、린수평축점승고,혈개、1,25 (OH)2 VitD3수평이급골밀도축점하강,우기이CKD4기화CKD5기최명현.
Objective To discuss the relationship between bone mineral salt metabolism index change and bone density in different stage of chronic kidney disease (CKD).Methods Three hundred and forty-five non-dialysis patients with CKD were enrolled in this study.According to the serum creatinine (SCr),glomerular filtration rate (GFR),they were divided into stage 1-5.CKD 1 had 75 cases,CKD 2 had 65 cases,CKD 3 had 65 cases,CKD 4 had 65 casès,CKD 5 had 75 cases.The level of blood calcium (Ca),phosphorus (P) and SCr were detected by ion selective electrode method.The level of urea nitrogen (BUN) was detected by picric acid method.The level of intact parathyroid hormone (iPTH) and 1,25 (OH)2VitD3 were detected by chemiluminescence.Results With the decline of renal function,the level of iPTH and blood P increased gradually,especially in stage CKD 4 and CKD 5,and compared with stage CKD 1,there were significantly differences [(289.6578 + 187.7945),(482.0667 + 232.2065) μ g/L vs.(77.8431 + 52.9760) μ g/L and (1.6938 + 0.1960),(2.6034 ± 0.5986) mmol/L vs.(1.3833 ± 0.4068) mmol/L,P ＜ 0.05].The level of blood Ca and 1,25 (OH)2VitD3 decreased gradually,especially in stage CKD 4 and CKD 5,and compared with stage CKD 1,there were significantly differences [(1.9185 +0.4633),(1.8293 ± 0.3075) mmol/L vs.(2.0893 + 0.2245) mmoi/L and (10.0892 + 0.2638),(7.6058 +0.4356) ng/L vs.(18.0036 + 0.3218) ng/L,P ＜ 0.05].With the decline of renal function,the proportion of osteoporosis also gradually increased,especially in stage CKDS,and compared with stage CKD 1 and CKD 2,there was significantly difference [60.00％ (45/75) vs.20.00％ (15/75),23.08％ (15/65),P ＜ 0.05].Conclusion With the decline of renal function,the level of blood P and iPTH increase,and blood Ca,1,25(OH)2VitD3,bone density decrease,especially in stage CKD 4 and CKD 5 patients.
