中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2015年
10期
1094-1098
,共5页
血液透析滤过%肾性骨营养障碍%钙代谢障碍%磷%甲状旁腺素
血液透析濾過%腎性骨營養障礙%鈣代謝障礙%燐%甲狀徬腺素
혈액투석려과%신성골영양장애%개대사장애%린%갑상방선소
Hemodiafiltration%Renal osteodystrophy%Calcium metabolism disorders%Phosphorus%Parathyroid hormone
目的 探讨老年维持性血液透析(MHD)患者矿物质代谢现况及相关影响因素,以提高本地区老年MHD患者生活质量和生存率. 方法 收集2012年1月至2013年8月新乡地区4家综合医院466例MHD治疗3个月及以上患者的临床资料,按年龄将其分为老年组(年龄≥60岁)159例和非老年组(年龄＜60岁)307例.检测所有患者的血清钙离子、磷、全段甲状旁腺激素(iPTH)及碱性磷酸酶(ALP)等矿物质代谢的评估指标.分析老年MHD患者矿物质代谢现况及其与贫血、透析龄、透析充分性、营养不良及炎症因子等因素的关系. 结果 466例患者中,血钙(1.95±0.34)mmol/L,血磷(2.54±1.38) mmol/L,iPTH(409.5±345.6)ng/L;钙、磷和iPTH达标率分别为34.3％、20.4％和25.5％,每周透析3次患者的钙、磷和iPTH达标率分别为50.8％、31.4％和32.2％.老年组患者血磷、iPTH、ALP、白蛋白、转铁蛋白饱和度低于非老年组(均P＜0.01),前白蛋白、血红蛋白、铁蛋白亦低于非老年组(均P＜0.05);而血钙、C反应蛋白明显高于非老年组(均P＜0.05). 结论 老年MHD患者矿物质代谢异常有其独特的临床变化,主要表现为低转运骨病,存在微炎症、营养不良,且贫血较非老年MHD患者更为严重.
目的 探討老年維持性血液透析(MHD)患者礦物質代謝現況及相關影響因素,以提高本地區老年MHD患者生活質量和生存率. 方法 收集2012年1月至2013年8月新鄉地區4傢綜閤醫院466例MHD治療3箇月及以上患者的臨床資料,按年齡將其分為老年組(年齡≥60歲)159例和非老年組(年齡＜60歲)307例.檢測所有患者的血清鈣離子、燐、全段甲狀徬腺激素(iPTH)及堿性燐痠酶(ALP)等礦物質代謝的評估指標.分析老年MHD患者礦物質代謝現況及其與貧血、透析齡、透析充分性、營養不良及炎癥因子等因素的關繫. 結果 466例患者中,血鈣(1.95±0.34)mmol/L,血燐(2.54±1.38) mmol/L,iPTH(409.5±345.6)ng/L;鈣、燐和iPTH達標率分彆為34.3％、20.4％和25.5％,每週透析3次患者的鈣、燐和iPTH達標率分彆為50.8％、31.4％和32.2％.老年組患者血燐、iPTH、ALP、白蛋白、轉鐵蛋白飽和度低于非老年組(均P＜0.01),前白蛋白、血紅蛋白、鐵蛋白亦低于非老年組(均P＜0.05);而血鈣、C反應蛋白明顯高于非老年組(均P＜0.05). 結論 老年MHD患者礦物質代謝異常有其獨特的臨床變化,主要錶現為低轉運骨病,存在微炎癥、營養不良,且貧血較非老年MHD患者更為嚴重.
목적 탐토노년유지성혈액투석(MHD)환자광물질대사현황급상관영향인소,이제고본지구노년MHD환자생활질량화생존솔. 방법 수집2012년1월지2013년8월신향지구4가종합의원466례MHD치료3개월급이상환자적림상자료,안년령장기분위노년조(년령≥60세)159례화비노년조(년령＜60세)307례.검측소유환자적혈청개리자、린、전단갑상방선격소(iPTH)급감성린산매(ALP)등광물질대사적평고지표.분석노년MHD환자광물질대사현황급기여빈혈、투석령、투석충분성、영양불량급염증인자등인소적관계. 결과 466례환자중,혈개(1.95±0.34)mmol/L,혈린(2.54±1.38) mmol/L,iPTH(409.5±345.6)ng/L;개、린화iPTH체표솔분별위34.3％、20.4％화25.5％,매주투석3차환자적개、린화iPTH체표솔분별위50.8％、31.4％화32.2％.노년조환자혈린、iPTH、ALP、백단백、전철단백포화도저우비노년조(균P＜0.01),전백단백、혈홍단백、철단백역저우비노년조(균P＜0.05);이혈개、C반응단백명현고우비노년조(균P＜0.05). 결론 노년MHD환자광물질대사이상유기독특적림상변화,주요표현위저전운골병,존재미염증、영양불량,차빈혈교비노년MHD환자경위엄중.
Objective To investigate the present state of mineral metabolism and its related factors in elderly patients with maintenance hemodialysis (MHD),in order to improve the quality of life and survival rate in elderly patients with MHD in Xinxiang.Methods Clinical data of 466 patients with treatment of MHD for over 3 months in 4 hospitals in Xinxiang district were enrolled from January 2012 to August 2013 in this study,and the patients were divided into the elderly group (n=159,aged ≥ 60 years) and the non-elderly group (n =307,aged ＜ 60 years).The evaluation indexes for mineral metabolism were determinated,such as serum levels of calcium,phosphorus,intact parathyroid hormone (iPTH) and alkaline phosphatase (ALP).The present state of mineral metabolism and its relationships with anemia,dialysis ages,adequacy of dialysis,malnutrition and inflammatory factors were analyzed in elderly patients with MHD.Results Among 466 patients,the serum levels of calcium,phosphorus and iPTH in MHD patients were (1.95 ± 0.34) mmol/L,(2.54±1.38) mmol/L and (409.5±345.6) ng/L respectively,and their control rates were 34.3％,20.4％ and 25.5％ respectively.And in patients with hemodialysis three times a week,the control rates were 50.8％,31.4％ and 32.2％ respectively.The serum levels of phosphorus,iPTH,ALP,albumin and transferrin saturation were lower in elderly group than in non-elderly group (all P＜0.01),and the serum levels of pre-albumin,hemoglobin and feritin were lower in elderly group than in non-elderly group (all P＜0.05).But the serum levels of calcium and C-reactive protein (CRP)were higher in elderly group than in non-elderly group (all P＜0.05).Conclusions The elderly patients with MHD exhibit unique clinical manifestations of abnormal mineral metabolism,and low bone transformation osteopathy is the main manifestation.The micro-inflammation,malnutrition and anemia are more severe in elderly patients than in non elderly patients.
