甲状旁腺激素对腹膜透析患者营养状况的影响及1,25(OH)_2D_3干预治疗的效果

Relationship Between Serum Level of Parathyroid Hormone and Nutritional Status of Continuous Ambulatory Peritoneal Dialysis Patients and the Therapeutic Effect of 1,25(OH)_2D_3

【目的】评价持续性腹膜透析(CAPD)患者甲状旁腺激素(iPTH)水平对营养状况的影响,并进行干预治疗,为改善患者营养状况提供临床依据。【方法】选择在本院腹膜透析中心随诊治疗的CAPD患者45例,所有患者均稳定透析3个月以上,测定其iPTH浓度,同时测定所有患者血红蛋白(Hb)、血清白蛋白(Alb)、前白蛋白(PA)浓度。测量人体指数学指标:肱三头肌皮褶(TSF)、肱二头肌皮褶(BSF)、上臂中部周径(MAC);使用改良整体主观评估法(MQSGA)评估患者营养状况;分析iPTH与各营养指标之间的关系。对存在继发性甲状旁腺功能亢进症(SHPT)的患者,分为对照组(常规低磷饮食,并补钙治疗),1,25(OH)2D3治疗组[常规低磷饮食、补钙治疗及1,25(OH)2D3干预治疗],治疗3个月后比较服用前后各组iPTH与各营养指标变化情况。【结果】iPTH与Hb、Alb、PA、MAC呈负相关(P<0.05);与MQSGA呈正相关(P<0.05)。45例CAPD患者中40例存在SHPT;1,25(OH)2D3治疗组治疗后iPTH、MQSGA均降低,Hb、Alb、PA、MAC增高,与治疗前相比差异有统计学意义。对照组iPTH及各营养指标无明显变化。【结论】iPTH是参与导致CAPD患者营养不良的重要因素。1,25(OH)2D3可通过降低CAPD患者的iPTH而改善其营养状态。

[Objective] To study the relationship between serum level of parathyroid hormone（PTH） and nutritional status of continuous ambulatory peritoneal dialysis（CAPD） patients and the therapeutic effect of 1. 25（OH）2D3. [Methods] Forty five CAPD patients were enrolled in this study. Serum iPTH. Hb. Aib and PA were measured. Anthropometric indices included MAC. BSF and TSF. Modified quantitative subjecnve global assessment （MQSGA） was evaluated to assess patients＇ nutritional status. The relationship between iPTH and nutritional status was analyzed. Patients with secondary hyperparathyroidism（SHPT） were asmgned to1 ,25（OH）2D3 therapy group and non-1,25 （OH）2 D3 therapy group. All above parameters were assayed again after 12 weeks. [Results] There were negative correlation between iPTH and Hb. Alb, PA. MAC（ P 〈 0.05） and positive correlation between iPTH and MQSGA（ P 〈0.05）. Forty five COPD patients were combined with SHPT. In 1,25 （OH）2 D3 therapy group, patients＇ serum PTH level and MQSGA were decreased. while Hb, Alb, PA and MAC were increased than before（ P 〈0.05）. The remarkably changes of PTH level. MQSGA, Hb, Alb, PA and MAC were not observed in non-1,25（OH）2D3 therapy group. [Conclusion] PTH can impact nutritional status of CAPD patients. 1,25 （OH）2 D3 can improve the nutrition status in CAPD patients by decreasing iPTH.