维持性血液透析患者肾功能、血清iPTH、钙、磷、外周血红系及血小板间的相关性分析

Correlations among renal function、serum level of iPTH、calcium、phosphonium、 peripheral erythroid cells and platelet in maintance hemodialysis patients

目的探讨维持性血液透析患者肾功能、血清全段甲状腺旁素(intact parathyroid hormone,iPTH)、血钙、血磷、外周血红系及血小板(PLT)间的相关性。方法选择我院52例长期维持血液透析的尿毒症患者作为病例组,40例健康体检者作为对照组,回顾性分析试验组患者临床资料及检验指标,比较两组的变化并对患者肾功能、血清iPTH、血钙、血磷、外周血红系及血小板间的相关性进行分析。结果与对照组相比,病例组患者血清尿素氮(BUN)、血清肌酐(Scr)、血清尿酸(UA)、血清iPTH、血磷(P)均升高,且差异有统计学意义(P<0.01),血钙(Ca)、血红蛋白(HGB)及PLT均降低,差异有统计学意义(P<0.01);血清iPTH与UA、P和CRP成正相关(r值分别为0.515,0.577,0.526,P<0.01);血清iPTH与HGB、PLT无相关性(P>0.05);血清铁饱和度(IS)与血清转铁蛋白(SF)、PLT呈正相关(r值分别为0.724,0.298,(P<0.05);HGB与IS、SF呈负相关(r值分别为-0.330、-0.433,P<0.05)。结论维持性血液透析尿毒症患者除肾功能受损外,普遍存在继发性甲旁亢、高磷、低钙及贫血等症状,且各项指标之间存在相关性,高磷是各种关系中相关性最强元素,有效的降低血磷对治疗患者继发性甲旁亢及由此引起的并发症,缓解病情均有重要的作用。

Objective To investigate the correlations among renal function, serum level of intact parathyroid hormone （iPTH）, serum calcium, serum phosphate, peripheral erythroid cells and platelet（PLT） in maintenance hemodialysis（MHD） patients. Methods Fifty-two MHD patients were enrolled as case cohort and fourty healthy volunteers were selected as control. Clinical and laboratory findings were analysed retrospectively, the correlations between laboratory findings were studied. Results Compared with the control cohort,blood urea nitrogen（BUN） ,serum creatinine（Scr）,urea acid（UA） ,iPTH,serum phosphate were higher in the MHD patients, while serum calcium, hemoglobin（HGB）,platelet（PLT） were lower, and both of the differences were statistically significant（P〈0.01） ;There was a significantly direct correlation of serum iPTH to UA, serum phos-phate and CRP（r=0.515,r=0.577,and r=0.526,P〈0.01） ,but no correlation of it to HGB and PLT（P〉0.05） ; There was a significantly direct correlation of IS （serum iron saturation） to SF and PLT（r=0.724 and r=0.298 ,P〈0.05）;While there was a significantly negative correlation of HGB to IS and SF（r=-0.330 and r=-0.433 ,P〈0.05）. Conclusion Except for renal dysfunction, it is common for MHD patients to have secondary hyperparathyroidism, hyperphosphatemia, hypocalcemia, anemia etc, and there were correlations among iPTH, serum calcium, serum phosphate, and so on. Hyperphosphatemia is an independent factor among them, So lowering serum phosphate effectively plays an important role in treating secondary hyperparathyroidism and its complications.