血PTH水平与尿毒症患者贫血及心血管疾病危险因素的相关性

Association between Parathyroid Hormone Level and Anemia, Risk Factors of Cardiovascular Disease in Uremic Patients

目的:探讨甲状旁腺素(PTH)水平与尿毒症患者贫血及心血管疾病(CVD)危险因素的相关性。方法:收集91例首次就诊住院的尿毒症(CKD5期)患者,按血i PTH水平将患者分为甲状旁腺功能亢进组和非亢进组,比较两组的临床资料。结果:继发性甲状旁腺功能亢进(SHPT)的患病率为40.66%,与非亢进组相比,亢进组患者的平均年龄较轻,贫血较重,血钙、甘油三酯、空腹血糖和超敏C反应蛋白水平较低,血磷和血肌酐水平较高,残余肾功能较差,两组间有显著性差异(P<0.05)。相关性分析显示血i PTH水平与年龄、血红蛋白、肌酐清除率、甘油三酯、血钙水平呈负相关(P<0.05),与血肌酐和血磷水平呈正相关(P<0.05)。结论:低血钙、高血磷、低肾小球滤过率是SHPT发生的危险因素,SHPT会加剧肾性贫血,PTH与其他CVD危险因素间的相关性不明显,提示其通过直接作用于心血管系统而增加CVD风险。

Objective：To elevate the association between parathyroid hormone level and anemia , risk factors of cardiovascular disease in uremic patients. Methods： Medical records of 91 resident patients who were diagnosed as uremia （CKD 5 stage） for the first time were reviewed and classified into SHPT group and non-SHPT group according to the intact parathyroid hormone （iPTH） level. We then examined clinical features between the two groups. Results：The prevalence of SHPT was 40.66%. It revealed significantly younger age, lower level of hemoglobin, calcium, triglyceride, fasting blood glucose, hs-CRP and GFR, higher level of phosphorus and creatinine in SHPT group （P〈0.05）. Correlation analysis showed that serum iPTH level was negatively correlated with age, hemoglobin, GFR, serum triglyceride and calcium level （P〈0.05）, but positively correlated with serum creatinine and phosphorus level （P〈0.05）. Conclusions： Hypocalcemia, hyperphosphatemia, lower GFR were risk factors of SHPT. Renal anemia was worsened by SHPT. The correlation between PTH and other risk factors of CVD were not obvious. It supported that PTH effected on the cardiovascular system directly to increase the risk of CVD.