国际泌尿系统杂志
國際泌尿繫統雜誌
국제비뇨계통잡지
INTERNATIONAL JOURNAL OF UROLOGY AND NEPHROLOGY
2014年
6期
896-900
,共5页
腹膜透析%碱性磷酸酶
腹膜透析%堿性燐痠酶
복막투석%감성린산매
Peritoneal Dialysis%Alkaline Phosphatase
目的 对维持腹膜透析患者的骨代谢指标进行横断面调查,并探讨腹膜透析时间对腹膜透析患者慢性肾脏疾病矿物质骨代谢异常(Chronic kidney disease-mineral and bone disorder,CKD-MBD)的影响.方法 以60例腹膜透析患者和30例健康体检者(对照组)作为研究对象,腹膜透析患者分为A组(腹膜透析时间＜24个月)和B组(腹膜透析时间≥24个月),比较各组间骨代谢指标,如血钙,血磷,25-羟维生素D3[25-hydroxyl vitamin D3,25 (OH) D3]、血清全段甲状旁腺素(intact parathyroid hormone,iPTH)和骨碱性磷酸酶(bone alkaline phosphatase,BALP)的变化.结果 与对照组相比,腹膜透析组的血磷升高,血钙降低且差异具有统计学意义(P1.40±0.29mmol/L vs 1.75±0.57mmol/L;Ca 2.33±0.19mmol/L 2.02±0.2mmol/L,P＜0.叭),iPTH,25 (OH) D3,BALP具有显著性差异[iPTH 436.41±368.28pg/mL vs 53.31±23.71pg/mL;25(OH)D3199.28±139.52ng/mL vs 36.04±14.17ng/mL;BALP80.24±39.41ng/mL vs 173.76±52.38ng/mL,P＜0.01].腹膜透析患者一项或多项骨代谢指标异常的发生率为100％.与对照组相比,A组、B组的血钙降低,血磷升高,且具有统计学意义;但A组与B组的血钙、血磷水平差异无统计学意义(P＞0.05).与对照组相比,A组、B组的iPTH显著升高(53.31±23.71pg/mL vs 596.57±449.91 pg/mL & 276.25±148.23pg/mL,P＜0.05);25(OH)D3显著减低[173.76±52.38ng/mL vs 58.99±25.79ng/mL & 101.48±39.67ng/mL,P＜0.05],A组BALP明显减低(36.04±14.18ng/mL vs 264.58±114.24ng/mL);与A组相比,B组的iPTH升高,25(OH)D3降低,BALP降低,且差异均具有统计学意义(BALP:133.97±133.90ng/mL vs 264.58±114.24ng/mL,P＜0.05).结论 腹膜透析患者存在明显的矿物质骨代谢异常.随着腹膜透析时间的增加,骨转化类型可能会发生变化,由于常规行骨活检较困难,需动态的检测患者的骨代谢血清学指标来辅助判断骨转化类型.腹膜透析患者矿物质骨代谢异常的治疗方案需根据骨转化类型进行调整.
目的 對維持腹膜透析患者的骨代謝指標進行橫斷麵調查,併探討腹膜透析時間對腹膜透析患者慢性腎髒疾病礦物質骨代謝異常(Chronic kidney disease-mineral and bone disorder,CKD-MBD)的影響.方法 以60例腹膜透析患者和30例健康體檢者(對照組)作為研究對象,腹膜透析患者分為A組(腹膜透析時間＜24箇月)和B組(腹膜透析時間≥24箇月),比較各組間骨代謝指標,如血鈣,血燐,25-羥維生素D3[25-hydroxyl vitamin D3,25 (OH) D3]、血清全段甲狀徬腺素(intact parathyroid hormone,iPTH)和骨堿性燐痠酶(bone alkaline phosphatase,BALP)的變化.結果 與對照組相比,腹膜透析組的血燐升高,血鈣降低且差異具有統計學意義(P1.40±0.29mmol/L vs 1.75±0.57mmol/L;Ca 2.33±0.19mmol/L 2.02±0.2mmol/L,P＜0.叭),iPTH,25 (OH) D3,BALP具有顯著性差異[iPTH 436.41±368.28pg/mL vs 53.31±23.71pg/mL;25(OH)D3199.28±139.52ng/mL vs 36.04±14.17ng/mL;BALP80.24±39.41ng/mL vs 173.76±52.38ng/mL,P＜0.01].腹膜透析患者一項或多項骨代謝指標異常的髮生率為100％.與對照組相比,A組、B組的血鈣降低,血燐升高,且具有統計學意義;但A組與B組的血鈣、血燐水平差異無統計學意義(P＞0.05).與對照組相比,A組、B組的iPTH顯著升高(53.31±23.71pg/mL vs 596.57±449.91 pg/mL & 276.25±148.23pg/mL,P＜0.05);25(OH)D3顯著減低[173.76±52.38ng/mL vs 58.99±25.79ng/mL & 101.48±39.67ng/mL,P＜0.05],A組BALP明顯減低(36.04±14.18ng/mL vs 264.58±114.24ng/mL);與A組相比,B組的iPTH升高,25(OH)D3降低,BALP降低,且差異均具有統計學意義(BALP:133.97±133.90ng/mL vs 264.58±114.24ng/mL,P＜0.05).結論 腹膜透析患者存在明顯的礦物質骨代謝異常.隨著腹膜透析時間的增加,骨轉化類型可能會髮生變化,由于常規行骨活檢較睏難,需動態的檢測患者的骨代謝血清學指標來輔助判斷骨轉化類型.腹膜透析患者礦物質骨代謝異常的治療方案需根據骨轉化類型進行調整.
목적 대유지복막투석환자적골대사지표진행횡단면조사,병탐토복막투석시간대복막투석환자만성신장질병광물질골대사이상(Chronic kidney disease-mineral and bone disorder,CKD-MBD)적영향.방법 이60례복막투석환자화30례건강체검자(대조조)작위연구대상,복막투석환자분위A조(복막투석시간＜24개월)화B조(복막투석시간≥24개월),비교각조간골대사지표,여혈개,혈린,25-간유생소D3[25-hydroxyl vitamin D3,25 (OH) D3]、혈청전단갑상방선소(intact parathyroid hormone,iPTH)화골감성린산매(bone alkaline phosphatase,BALP)적변화.결과 여대조조상비,복막투석조적혈린승고,혈개강저차차이구유통계학의의(P1.40±0.29mmol/L vs 1.75±0.57mmol/L;Ca 2.33±0.19mmol/L 2.02±0.2mmol/L,P＜0.팔),iPTH,25 (OH) D3,BALP구유현저성차이[iPTH 436.41±368.28pg/mL vs 53.31±23.71pg/mL;25(OH)D3199.28±139.52ng/mL vs 36.04±14.17ng/mL;BALP80.24±39.41ng/mL vs 173.76±52.38ng/mL,P＜0.01].복막투석환자일항혹다항골대사지표이상적발생솔위100％.여대조조상비,A조、B조적혈개강저,혈린승고,차구유통계학의의;단A조여B조적혈개、혈린수평차이무통계학의의(P＞0.05).여대조조상비,A조、B조적iPTH현저승고(53.31±23.71pg/mL vs 596.57±449.91 pg/mL & 276.25±148.23pg/mL,P＜0.05);25(OH)D3현저감저[173.76±52.38ng/mL vs 58.99±25.79ng/mL & 101.48±39.67ng/mL,P＜0.05],A조BALP명현감저(36.04±14.18ng/mL vs 264.58±114.24ng/mL);여A조상비,B조적iPTH승고,25(OH)D3강저,BALP강저,차차이균구유통계학의의(BALP:133.97±133.90ng/mL vs 264.58±114.24ng/mL,P＜0.05).결론 복막투석환자존재명현적광물질골대사이상.수착복막투석시간적증가,골전화류형가능회발생변화,유우상규행골활검교곤난,수동태적검측환자적골대사혈청학지표래보조판단골전화류형.복막투석환자광물질골대사이상적치료방안수근거골전화류형진행조정.
Objectives To investigate the bone metabolic biomarkers of peritoneal dialysis and to study the effect of maintenance dialysis periods on chronic kidney disease-mineral and bone disorder(CKD-MBD) in peritoneal dialysis.Methods We observed the change of bone metabolic biochemical markers:serum calcium and phosphorus,intact parathyroid hormone (iPTH),25-hydroxy vitamin D3 [25 (OH) D3)] and bone alkaline phosphatase (BALP) in the participants,which contained 60 peritoneal dialysis patients and 30 healthy controls.Furthermore,the peritoneal dialysis patients were grouped into A (maintenance dialysis periods ＜ 24 months) and B (maintenance dialysis periods ≥24 months).Results Compared to the healthy control,the level of serum calcium went down,while serum phosphate went up obviously (P 1.40 ± 0.29mmol/L vs 1.75 ± 0.57mmoL/L; Ca 2.33 ± 0.19mmol/l 2.02 ± 0.2mmol/l,P ＜ 0.01),at the same time,the level of iPTH,25 (OH) D3 and BALP showed obviously change in iPTH,25 (OH) D3 and BALP [iPTH 436.41 ± 368.28pg/ml vs 53.31 ± 23.71pg/ml; 25 (OH)D3 199.28 ± 139.52ng/ml vs 36.04 ±14.17ng/ml; BALP 80.24 ± 39.41ng/ml vs 173.76 ±52.38ng/ml,P ＜0.01].The rate was nearly 100％ that at least one of bone metabolic biochemical markers was abnormal.Compared to the healthy control,the level of serum calcium and phosphate changed obviously in group A and B.While the level of serum calcium and phosphate did not show difference obviously in group A and B (P ＞ 0.05).Compared to the healthy control,the level of iPTH raised (iPTH 53.31 ± 23.71pg/ml vs 596.57 ±449.91pg/ml & 276.25 ± 148.23pg/ml,P ＜ 0.05),25 (OH) D3 declined [25 (OH) D3:173.76 ± 52.38ng/ml vs 58.99 ± 25.79ng/ml & 101.48 ± 39.67ng/ml,P ＜0.05] in group A and B,while BALP went up (BALP:36.04 ± 14.18ng/ml vs 264.58 ± 114.24ng/ml) in group A.Compared to the level of iPTH,25 (OH)D3,BALP in group A,in group B,iPTH increased significantly,although the concentration of 25 (OH)D3 and BALP dropped obviously (BALP:133.97 ± 133.90ng/ml vs 264.58 ± 114.24ng/ml,P ＜ 0.05).Conclusions CKD-MBD was widespread in peritoneal dialysis patients.The bone turnover type may be converted by the peritoneal dialysis time going on.Due to the difficulty of bone biopsy,the dynamic monitoring of bone metabolic biomarkers was necessary to explicit the bone turnover type.Therapies tailored particularly to different turnover bone should be taken appropriately in peritoneal dialysis.
