中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2014年
1期
29-34
,共6页
杨晓晓%姜娜%黄佳颖%顾爱萍%林爱武%张琳%倪兆慧%钱家麒%方炜
楊曉曉%薑娜%黃佳穎%顧愛萍%林愛武%張琳%倪兆慧%錢傢麒%方煒
양효효%강나%황가영%고애평%림애무%장림%예조혜%전가기%방위
高磷血症%代谢清除率%腹膜透析%磷摄入
高燐血癥%代謝清除率%腹膜透析%燐攝入
고린혈증%대사청제솔%복막투석%린섭입
Hyperphosphatemia%Metabolic clearance rate%Peritoneal dialysis%Phosphorus intake
目的 分析合并高磷血症的腹膜透析(腹透)患者的临床特征,探讨影响腹透患者发生高磷血症的相关因素.方法 入选在上海交通大学医学院附属仁济医院腹透中心接受稳定、规律腹膜透析3个月以上的患者100例,根据血磷水平分为高血磷组(血磷≥1.6 mmol/L)和正常血磷组(血磷＜ 1.6 mmol/L).记录所有入选患者3d的饮食日记,评估饮食中磷、蛋白质、热量的摄入量.检测患者血清白蛋白、血磷、血钙、血清甲状旁腺激素(iPTH)、超敏C反应蛋白(hCRP)、血钾等指标.评估患者腹膜及残肾的磷清除率、残肾功能(RRF)、总肌酐清除率(Ccr)、腹透超滤量等.记录患者降磷药物及活性维生素D的使用情况.采用多元逐步回归法分析影响腹透患者血磷水平的独立相关因素.结果 与正常血磷组相比,高血磷组患者的饮食磷摄入量[(13.03±3.39)比(10.65±3.04) mg· kg IBW-1·d-1]和蛋白质摄入量[(0.96±0.30)比(0.80±0.27) mg· kg IBW-1·d-1]较高(均P＜ 0.05).腹膜磷清除率[(21.80±9.90)比(27.74±11.23)L·周-1·(1.73m2)-1]、残肾磷清除率[1.38(0,12.38)比10.30(0,21.97)L·周-1·(1.73 m2)-1]和总Ccr[(59.7±18.5)比(68.3±23.1)L·周-1·(1.73 m2)-1]较低(均P＜0.05);高血磷组中无尿患者比例(46％比24％)、1.25 mmol/L钙浓度透析液的使用比例(66％比40％)、血钾水平[(4.4±0.8)比(3.9±0.6) mmol/L]均较正常血磷组高(均P＜0.05).两组患者中血清白蛋白、超敏C反应蛋白、血钙等指标以及碳酸钙和活性维生素D使用比例与剂量的差异无统计学意义(均P＞ 0.05).多元逐步回归分析结果显示:饮食磷摄入量(β=0.043,P＜0.01)、腹膜磷清除率(β=-0.008,P＜0.05)、残肾功能(β=-0.07,P＜0.01)和log[iPTH](β=0.262,P＜0.01)是影响血磷水平的独立相关因素.结论 合并高磷血症的腹透患者存在饮食磷摄入量高、磷清除率低以及无尿患者比例高等临床特征,饮食磷摄入、腹膜磷清除率、残肾功能和血iPTH是影响腹透患者血磷水平的独立相关因素.
目的 分析閤併高燐血癥的腹膜透析(腹透)患者的臨床特徵,探討影響腹透患者髮生高燐血癥的相關因素.方法 入選在上海交通大學醫學院附屬仁濟醫院腹透中心接受穩定、規律腹膜透析3箇月以上的患者100例,根據血燐水平分為高血燐組(血燐≥1.6 mmol/L)和正常血燐組(血燐＜ 1.6 mmol/L).記錄所有入選患者3d的飲食日記,評估飲食中燐、蛋白質、熱量的攝入量.檢測患者血清白蛋白、血燐、血鈣、血清甲狀徬腺激素(iPTH)、超敏C反應蛋白(hCRP)、血鉀等指標.評估患者腹膜及殘腎的燐清除率、殘腎功能(RRF)、總肌酐清除率(Ccr)、腹透超濾量等.記錄患者降燐藥物及活性維生素D的使用情況.採用多元逐步迴歸法分析影響腹透患者血燐水平的獨立相關因素.結果 與正常血燐組相比,高血燐組患者的飲食燐攝入量[(13.03±3.39)比(10.65±3.04) mg· kg IBW-1·d-1]和蛋白質攝入量[(0.96±0.30)比(0.80±0.27) mg· kg IBW-1·d-1]較高(均P＜ 0.05).腹膜燐清除率[(21.80±9.90)比(27.74±11.23)L·週-1·(1.73m2)-1]、殘腎燐清除率[1.38(0,12.38)比10.30(0,21.97)L·週-1·(1.73 m2)-1]和總Ccr[(59.7±18.5)比(68.3±23.1)L·週-1·(1.73 m2)-1]較低(均P＜0.05);高血燐組中無尿患者比例(46％比24％)、1.25 mmol/L鈣濃度透析液的使用比例(66％比40％)、血鉀水平[(4.4±0.8)比(3.9±0.6) mmol/L]均較正常血燐組高(均P＜0.05).兩組患者中血清白蛋白、超敏C反應蛋白、血鈣等指標以及碳痠鈣和活性維生素D使用比例與劑量的差異無統計學意義(均P＞ 0.05).多元逐步迴歸分析結果顯示:飲食燐攝入量(β=0.043,P＜0.01)、腹膜燐清除率(β=-0.008,P＜0.05)、殘腎功能(β=-0.07,P＜0.01)和log[iPTH](β=0.262,P＜0.01)是影響血燐水平的獨立相關因素.結論 閤併高燐血癥的腹透患者存在飲食燐攝入量高、燐清除率低以及無尿患者比例高等臨床特徵,飲食燐攝入、腹膜燐清除率、殘腎功能和血iPTH是影響腹透患者血燐水平的獨立相關因素.
목적 분석합병고린혈증적복막투석(복투)환자적림상특정,탐토영향복투환자발생고린혈증적상관인소.방법 입선재상해교통대학의학원부속인제의원복투중심접수은정、규률복막투석3개월이상적환자100례,근거혈린수평분위고혈린조(혈린≥1.6 mmol/L)화정상혈린조(혈린＜ 1.6 mmol/L).기록소유입선환자3d적음식일기,평고음식중린、단백질、열량적섭입량.검측환자혈청백단백、혈린、혈개、혈청갑상방선격소(iPTH)、초민C반응단백(hCRP)、혈갑등지표.평고환자복막급잔신적린청제솔、잔신공능(RRF)、총기항청제솔(Ccr)、복투초려량등.기록환자강린약물급활성유생소D적사용정황.채용다원축보회귀법분석영향복투환자혈린수평적독립상관인소.결과 여정상혈린조상비,고혈린조환자적음식린섭입량[(13.03±3.39)비(10.65±3.04) mg· kg IBW-1·d-1]화단백질섭입량[(0.96±0.30)비(0.80±0.27) mg· kg IBW-1·d-1]교고(균P＜ 0.05).복막린청제솔[(21.80±9.90)비(27.74±11.23)L·주-1·(1.73m2)-1]、잔신린청제솔[1.38(0,12.38)비10.30(0,21.97)L·주-1·(1.73 m2)-1]화총Ccr[(59.7±18.5)비(68.3±23.1)L·주-1·(1.73 m2)-1]교저(균P＜0.05);고혈린조중무뇨환자비례(46％비24％)、1.25 mmol/L개농도투석액적사용비례(66％비40％)、혈갑수평[(4.4±0.8)비(3.9±0.6) mmol/L]균교정상혈린조고(균P＜0.05).량조환자중혈청백단백、초민C반응단백、혈개등지표이급탄산개화활성유생소D사용비례여제량적차이무통계학의의(균P＞ 0.05).다원축보회귀분석결과현시:음식린섭입량(β=0.043,P＜0.01)、복막린청제솔(β=-0.008,P＜0.05)、잔신공능(β=-0.07,P＜0.01)화log[iPTH](β=0.262,P＜0.01)시영향혈린수평적독립상관인소.결론 합병고린혈증적복투환자존재음식린섭입량고、린청제솔저이급무뇨환자비례고등림상특정,음식린섭입、복막린청제솔、잔신공능화혈iPTH시영향복투환자혈린수평적독립상관인소.
Objective To sort the clinical features associated with hyperphosphatemia in peritoneal dialysis (PD) patients.Methods The patients who had been on stable PD at least three months were eligible to enroll.All patients were instructed to record 3 days food diary in order to obtain the daily dietary phosphorus,protein and calorie intake.The peritoneal and renal clearance of phosphorus,residual renal function (RRF) and total creatinine clearance (Ccr) were calculated.Laboratory parameters,including serun albumin,phosphorus,calcium,intact parathyroid hormone (iPTH),high sensitivity C reactive protein (hs-CRP),potassium were measured.Prescription of oral phosphorus binders and active vitamin D were recorded.Results A total of 100 PD patients were enrolled and divided into two groups according to their serum phosphorus levels,including high serum phosphorus group (≥ 1.6 mnmol/L,n =50) and normal serum phosphorus group (＜ 1.6 mmol/L,n =50).Compared to the patients with normal serum phosphorus,hyperphosphatemic PD patients had significantly higher dietary phosphorus [(13.03±3.39) vs (10.65± 3.04) rmg· kg IBW-1· d-1] and protein intake [(0.96±0.30) vs (0.80±0.27) mg·kg IBW-1· d-1],while peritoneal phosphorus clearance [(21.8±9.90) vs (27.74±11.23) L· wk-1· (1.73 m2)-1],renal phosphorus clearance [1.38(0,12.38) vs 10.30(0,21.97) L· wk-1· (1.73 m2)-1] and total Ccr [(59.7±18.5) vs (68.3±23.1) L· wk-1 ·(1.73 m2)-1] were lower (all P ＜ 0.05).Patients with hyperphosphatemia showed higher prevalence of anuria (46％ vs 24％) and more frequent usage of dialysate with 1.25 mmol/L calcium (66％ vs 40％) compared to their counterparts with normal serum phosphorus (all P ＜ 0.05).In addition,serum potassium levels in patients with hyperphosphatemia were higher [(4.4 ± 0.8) vs (3.9 ± 0.6) mmol/L,P ＜ 0.05].Multiple stepwise regression analysis showed that dietary phosphorus intake (β =0.043,P ＜ 0.01),peritoneal phosphorus clearance （β =-0.008,P ＜ 0.05),RRF （β =-0.07,P ＜ 0.01) and log[iPTH] (β =0.262,P ＜0.01) were independently associated with serum phosphorus level in PD patients.Conclusions PD patients with hyperphosphatemia have higher dietary phosphorus intake,lower phosphorus clearance and are more tended to be anuric.Dietary phosphorus intake,peritoneal phosphorus clearance,residual renal function and serum iPTH are independent factors associated with serum phosphorus levels in PD patients.
