透析患者甲状旁腺素水平的临床观察

Clinical Observation on the Parathyroid Hormone Levels of Hemodialysis Patients

目的探讨透析患者在透析治疗后的血清甲状旁腺素(iPTH)水平状况及其相关因素。方法对98例透析患者采用电化学发光免疫分析法检测血清iPTH水平,并横断面调查透析患者的骨痛情况及超声检查甲状旁腺。结果透析患者血清iPTH水平与血磷、透龄及血白蛋白均呈正相关(r=7.465,P<0.001;r=4.523,P<0.02;r=7.437,P<0.001)。HD组血磷及iPTH水平较PD组明显增高(P<0.002、0.005),HD组血磷≥2.6 mmol/L的患者血清iPTH水平较<2.6 mmol/L的患者血清iPTH水平明显增高(P<0.05),透析≥3年的血清iPTH水平比<3年的明显增高(P<0.05),而PD组均无统计学意义(P>0.05)。透析患者血白蛋白≥3.5 g/L较<3.5 g/L的血清iPTH水平明显增高(P<0.05)。HD组骨痛及甲状旁腺瘤发生率明显高于PD组(分别为46.6%和4.8%,X2=19.390,t<0.005;10.5%和0%,X2=4.597,t<0.05)。HD组有骨痛患者较无骨痛患者的血清iPTH水平明显增高(P<0.01)。结论 HD对血清iPTH的清除明显低于PD,骨痛及甲状旁腺瘤发生率也较高,HD 3年以上且血磷≥2.6 mmol/L的患者更应该注意继发性甲状旁腺素功能亢进。

Objective To discuss the iPTH level and related factors of hemodialysis patients after the hemodialysis.Methods To detect the iPTH level of 98 hemodialysis patients with electrochemiluminescence immunoassay and survey the ostealgia situation of hemodialysis patients and check the parathyroid by ultrasound.Results iPTH level of hemodialysis patients had a positive correlation with phosphorus,hemodialysis period and albumin（r=7.465,P〈0.001;r=4.523,P0.02;r=7.437,P〈0.001）.Phosphorus and iPTH level in HD group increased significantly compared with that of PD group（P〈0.002,0.005）;iPTH level of the patients with phosphorus≥2.6 mmol/L in HD group increased significantly compared with that of PD group;iPTH level with the hemodialysis period≥3 years increased significantly compared with that with the hemodialysis period3 years（P〈0.05）,without statistical significance in PD group.iPTH level of the patients with albumin ≥3.5 g/L compared with that with 3.5 g/L increased significantly（P〈0.05）.The incidence of ostealgia and parathyroid tumor in HD group was significantly higher than that of PD group（46.6%和4.8%,X2 =19.390,t0.005;10.5%和0%,X2 =4.597,t0.05）.iPTH level of the patients with ostealgia increased significantly compared with that without ostealgia（P〈0.01）.Conclusion The clearance of iPTH in HD group was significantly lower that of PD group,the incidence of ostealgia and parathyroid tumor was higher.The patients with phosphorus≥2.6 mmol/L through HD for over 3 years should pay attention to secondary hyperparathyroidism bone disease.