CAJ | 학술논문

目的初步探讨重症肾性继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)合并Sagliker综合征(Sagliker syndrome,SS)的临床特点和相关危险因素.方法纳入2011年2月至2015年4月在安徽医科大学第二附属医院肾脏内科确诊重症肾性SHPT患者229例,其中SS组33例,余196例为对照组.比较两组患者在年龄、性别等人口学资料、并发症及血清学指标方面的差异,分析导致SS可能的危险因素.结果 SS组患者中位透析龄为11年,显著长于对照组(8年),差异有统计学意义(P＜ 0.001);与对照组比较,SS组患者血肌酐、血尿素氮、白蛋白、血磷水平较低,而全段甲状旁腺激素(iPTH)、铁蛋白、超敏C反应蛋白、碱性磷酸酶(ALP)、心瓣膜及腹主动脉钙化比例较高,差异均有统计学意义(均P＜ 0.05);单因素Logistic回归分析结果显示,长透析龄(＞10年,OR=6.182,P=0.002)、高ALP(＞347 U/L,OR=5.786,P=0.002)、高iPTH(＞1764 ng/L,OR=4.960,P=0.001)、心瓣膜及腹主动脉钙化(OR=8.635,P＜0.001;OR=5.039,P=0.001)均是发生SS的危险因素,高血清白蛋白是SS的保护因素(OR=0.904,P=0.014);多因素回归分析结果显示,长透析龄(＞10年,OR=5.121,P=0.036)、高iPTH(＞1764 ng/L,OR=4.130,P=0.017)、心瓣膜钙化(OR=1 1.714,P＜ 0.001)是SS的独立危险因素.结论长透析龄及高iPTH是重症SHPT患者发生SS的独立危险因素.
목적 초보탐토중증신성계발성갑상방선공능항진(secondary hyperparathyroidism,SHPT)합병Sagliker종합정(Sagliker syndrome,SS)적림상특점화상관위험인소.방법 납입2011년2월지2015년4월재안휘의과대학제이부속의원신장내과학진중증신성SHPT환자229례,기중SS조33례,여196례위대조조.비교량조환자재년령、성별등인구학자료、병발증급혈청학지표방면적차이,분석도치SS가능적위험인소.결과 SS조환자중위투석령위11년,현저장우대조조(8년),차이유통계학의의(P＜ 0.001);여대조조비교,SS조환자혈기항、혈뇨소담、백단백、혈린수평교저,이전단갑상방선격소(iPTH)、철단백、초민C반응단백、감성린산매(ALP)、심판막급복주동맥개화비례교고,차이균유통계학의의(균P＜ 0.05);단인소Logistic회귀분석결과현시,장투석령(＞10년,OR=6.182,P=0.002)、고ALP(＞347 U/L,OR=5.786,P=0.002)、고iPTH(＞1764 ng/L,OR=4.960,P=0.001)、심판막급복주동맥개화(OR=8.635,P＜0.001;OR=5.039,P=0.001)균시발생SS적위험인소,고혈청백단백시SS적보호인소(OR=0.904,P=0.014);다인소회귀분석결과현시,장투석령(＞10년,OR=5.121,P=0.036)、고iPTH(＞1764 ng/L,OR=4.130,P=0.017)、심판막개화(OR=1 1.714,P＜ 0.001)시SS적독립위험인소.결론 장투석령급고iPTH시중증SHPT환자발생SS적독립위험인소.
Objective To explore the clinical characteristics and related risk factors in patients with severe uremic secondary hyperparathyroidism (SHPT) complicated with Sagliker syndrome (SS).Methods A total of 229 patients with severe uremic SHPT admitted in our hospital from February 2011 to April 2015 were enrolled, among which 33 cases were taken as positive group (SS group), and 196 cases as control group.The differences between two groups in demographic data (such as gender and age), complications, and biochemical indexes were compared, with potential risk factors of SS being analyzed.Results There were significant differences between median duration of dialysis in positive group (11 years) and that in control group (8 years, P ＜ 0.001).Compared to control group, the patients in SS group had lower levels of serum creatinine (Scr), blood urea nitrogen (BUN),albumin (Alb), phosphorus (P), and higher serum levels of parathyroid hormone (iPTH), ferritin,hypersensitive C-reactive protein and alkaline phosphatase (ALP), as well as higher calcification in heart valves and abdominal aortic (all P ＜ 0.05).The unadjusted logistic regression models showed that longer duration of dialysis (＞ 10 years, OR=6.182, P=0.002), higher serum levels of ALP (＞ 347 U/L,OR=5.786, P=0.002) and iPTH (＞ 1764 rig/L, OR=4.960, P=0.001), and calcification in heart valves and abdominal aortic (OR=8.635, P ＜ 0.001;OR=5.039, P=0.001) were associated with increased risks of SS, and higher set-um Alb was a protect factor for SS (OR=0.904, P=0.014).The multivariate regression analysis showed that longer duration of dialysis (＞ 10 years, OR=5.121, P=0.036), higher serum level of iPTH (＞ 1764 ng/L, OR=4.130, P=0.017), calcification in heart valves (OR=1 1.714, P ＜0.001) were independent risk factors of SS.Conclusions Severe uremic SHPT patients with longer duration of dialysis and higher serum level of iPTH are more likely to develop SS.