慢性肾衰竭伴甲状旁腺激素升高的相关因素分析

The Risk Factor for Chronic Renal Failure with Hyper-iPTH

目的：探讨影响慢性肾衰竭患者血浆全段甲状旁腺激素（iPTH）水平升高的相关因素。方法：对2002年1月～2004年8月在我院住院的未使用含钙的磷结合剂和值活性维生素D的79例慢性肾衰竭患者的临床资料进行回顾性分析，比较慢性肾衰竭伴或不伴iPTH升高的患者中临床表现和实验室检查等方面的差别，利用单因素及多因素分析探讨影响慢性肾衰竭患者伴iPTH升高的危险因素．结果：本组伴发iPTH升高的发生率为62.0％，单因素分析提示，患者性别、年龄、病程、尿蛋白≥2g／24h及血浆白蛋白≤35g／L与慢性肾衰竭iPTH升高的发生不相关；血钙≤2．12mmol／L，血磷≥1．62mmol／L、血肌酐≥353ttmol／L、二氧化碳结合率≤18mmol／L、Hb≤90g／L、血压≥140／90mmHg是慢性肾衰竭继发iPTH升高的危险因素，且血清磷与血肌酐水平是慢性肾衰竭继发iPTH升高的独立危险因素。结论：继发iPTH升高是慢性肾衰竭常见并发症，发生率高，其发生与血钙、血磷、二氧化碳结合率、血红蛋白、肌酐及血压水平等因素密切相关，应及时有效的防治继发甲状旁腺功能亢进的发生。

Objective：To investigate the risk factors for chronic renal failure （CRF） with increased intact parathyroid hormone （iPTH）, Methods： The datas of 79 CRF patients who did not take calcium- containing phosphate binders and/ or vitamin D from January 2001 to August 2004 were analyzed retrospectively. Clinical and laboratory findings were compared between CRF with hyper- iPTH and without hyper- iPTH. Results： the incidence of hyper - iPTH was 62.0% （49/79）. Single- variable analysis showed that sex. age, the duration of disease, proteinuri≥2 g/24 h, and plasma - albumins≤35 g/L were not the main risk factors of hyper - iPTH occurred in patients with CRF while serum calcium≤2.12 mmol/L, serum phosphorus≥1.62 mmol/L,serum creatinine≥353 μmol/L, CO2CP≤ 18 mmol/L, lib（haemoglobin）490 g/L, and bloot pressure≥140/90 mmHg were the main risk factors of hyper- iPTH occurred in patients with CRF. Multi- variable Logistic analysis showed that independent factors of hyper- iPTH in patients with CRF included serum phosphorus and serum creatnine. Conclusion：Secondary hyperparathyroidism is a common complication of CRF. High incidence of hyper- iPTH is associated with .serum calcium, serum phosphorus, serum creatinine. CO2CP, Hb, and blood pressure. Early intervention is important in lowering the incidence of secondary hyperparathyroidism and improving the prognosis of CRF.