CAJ | 학술논문

目的探讨维持性血液透析患者甲状旁腺增生的影响因素.方法对北京安贞医院肾内科维持性血液透析治疗1年以上的71例患者进行甲状旁腺超声检查,根据患者是否存在甲状旁腺增生分为甲状旁腺增生组(33例)和甲状旁腺非增生组(38例).统计分析甲状旁腺增生与患者年龄、透析时间及血钙(校正钙)、血磷、全段甲状旁腺激素(iPTH)、总碱性磷酸酶(ALP)、25-羟维生素D等指标之间的关系.结果有71例患者接受甲状旁腺的超声检查,其中甲状旁腺增生组的患者占46.5％(33/71),非增生组患者占53.5％(38/71),2组间透析时间、血磷、iPTH水平差异有统计学意义[(64±40)个月比(44 ±33)个月,(2.2±0.5) mmol/L比(2.0±0.5) mmol/L,600(505,1 060) ng/L比299(191,433) ng/L](P＜0.05或P＜0.01).对年龄、透析时间及血钙、血磷、ALP、iPTH、25-羟维生素D水平的单因素分析结果显示,甲状旁腺增生与透析时间、血磷、iPTH、ALP呈正相关(r=0.293,r=0.533,r=0.269,r=0.308,P＜0.05);对上述指标进行Logistic回归分析显示仅iPTH与甲状旁腺增生存在独立相关性(P＜0.05).受试者工作特征曲线分析表明iPTH水平能高度提示甲状旁腺增生,曲线下面积及95％置信区间为0.852(0.757 ～0.946),对应界定值为513 ng/L,相对应的敏感度为75.8％,特异性为86.8％.结论维持性血液透析患者的透析时间、血磷是甲状旁腺增生的影响因素,而iPTH大于513 ng/L提示存在甲状旁腺增生.
목적 탐토유지성혈액투석환자갑상방선증생적영향인소.방법 대북경안정의원신내과유지성혈액투석치료1년이상적71례환자진행갑상방선초성검사,근거환자시부존재갑상방선증생분위갑상방선증생조(33례)화갑상방선비증생조(38례).통계분석갑상방선증생여환자년령、투석시간급혈개(교정개)、혈린、전단갑상방선격소(iPTH)、총감성린산매(ALP)、25-간유생소D등지표지간적관계.결과 유71례환자접수갑상방선적초성검사,기중갑상방선증생조적환자점46.5％(33/71),비증생조환자점53.5％(38/71),2조간투석시간、혈린、iPTH수평차이유통계학의의[(64±40)개월비(44 ±33)개월,(2.2±0.5) mmol/L비(2.0±0.5) mmol/L,600(505,1 060) ng/L비299(191,433) ng/L](P＜0.05혹P＜0.01).대년령、투석시간급혈개、혈린、ALP、iPTH、25-간유생소D수평적단인소분석결과현시,갑상방선증생여투석시간、혈린、iPTH、ALP정정상관(r=0.293,r=0.533,r=0.269,r=0.308,P＜0.05);대상술지표진행Logistic회귀분석현시부iPTH여갑상방선증생존재독립상관성(P＜0.05).수시자공작특정곡선분석표명iPTH수평능고도제시갑상방선증생,곡선하면적급95％치신구간위0.852(0.757 ～0.946),대응계정치위513 ng/L,상대응적민감도위75.8％,특이성위86.8％.결론 유지성혈액투석환자적투석시간、혈린시갑상방선증생적영향인소,이iPTH대우513 ng/L제시존재갑상방선증생.
Objective To evaluate the influence factors of parathyroid hyperplasia in the maintenance hemodialysis(MHD) patients.Results A total of 71 MHD patients from March 2012 to March 2013 were included in this study.The patients were divided into parathyroid hyperplasia group(33 cases) and non-hyperplasia group (38 cases).The relation among parathyroid hyperplasia,duration of dialysis,serum calcium,phosphorus,parathyroid hormone (intact parathyroid hormone,iPTH),total alkaline phosphatase,and 25-hydroxy vitamin D levels were analyzed.Finally,receiver operating characteristic(ROC) curve was done to find out the boundary values of diagnosis parathyroid hyperplasia.Results Between the two groups,blood phosphorus,duration of dialysis and iPTH had statistical differences [(64 ± 40) months vs (44 ± 33) months,(2.2 ± 0.5) mmol/L vs (2.0 ± 0.5) mmol/L,600 (505,1 060) ng/L vs 299 (191,433) ng/L] (P ＜ 0.05 or P ＜ 0.01).Logistic regression analysis indicated that iPTH had independent correlation with parathyroid hyperplasia.ROC curve indicated that using iPTH to prompt the standard of parathyroid hyperplasia was accurate.The boundary level of iPTH prompting parathyroid hyperplasia was 513 ng/L.Conclusions Parathyroid hyperplasia is correlated with duration of dialysis and serum phosphorus.If level of iPTH is greater than 513 ng/L,it highly suggests hyperplasia of parathyroid.