高磷血症维持性血液透析患者的临床分析

The Clinical Analysis of Hyperphosphatemia in Maintenance Hemodialysis Patients

目的:比较不同血磷水平的维持性血液透析的尿毒症患者的临床表现和实验室指标,探讨其临床意义。方法:选择上海交通大学医学院附属新华医院(崇明)肾内科28例高血磷(SP>1.6mmol/L)的维持性血液透析患者为病例组,30例血磷正常(SP≤1.6mmol/L)维持性血液透析患者为对照组,比较两组患者的原发病组成,年龄,性别,透析龄,皮肤瘙痒发生率,腰背痛发生率,血钙,血碳酸氢根,血红蛋白,红细胞压积,血碱性磷酸酶,肾功能,血浆白蛋白水平及左心室肥厚发生率。结果:病例组与对照组在原发病组成,年龄(43.2±9.8岁vs 40.5±12.2岁),男女性别比例(16/12 vs.17/13),透析龄(32.56±6.71月vs.35.43±5.82月)等方面无显著性差异(P>0.05),有可比性,在血红蛋白(83.22±6.71g/L vs 103.36±5.84g/L),红细胞压积(24.83±1.92%vs.30.76±1.52%),血钙(1.71±0.16mmol/L vs.2.23±0.21 mmol/L),血碳酸氢根(14.2±3.1mmol/L vs 20.6±4.9 mmol/L),血碱性磷酸酶(124.26±16.33U/L vs.61.47±14.91 U/L),皮肤瘙痒发生率(22/28 vs.7/30),腰背痛发生率(19/28 vs.6/30),左心室肥厚发生率(20/28 vs 12/30),有显著性差异(P<0.05),肌酐(956±142mmol/L vs.923±156 mmol/L),尿素氮(23.1±6.3mmol/L vs.24.8±8.9mmol/L),血浆白蛋白(30.5±3.8g/L vs.31.2±2.9g/L),无显著性差异(P>0.05)。结论:伴有高磷血症的维持性血液透析患者与血磷正常的患者相比,血碱性磷酸酶,皮肤瘙痒发生率,腰背痛发生率及左心室肥厚发生率较高,而血钙,血碳酸氢根,血红蛋白及红细胞压积较低,有一定差异。

Objective： To compare the clinical feature and laboratory examination indexes of different serum phosphorus levels in uremia patients treated with maintenance hemodialysis and explore its clinical significance. Methods：According to the serum phosphorus levels, 58 maintenance hemodialysis patients from department ofnephrology, Xinghua Hospital Affiliated to Shanghai Jiaotong Universi- ty School of Medicine were divided into two groups, including 28 cases of case group （SP〉1.6mmol/L） and 30 cases of control group （SP〈 1.6mmol/L）. The protopathy, age, gender, duration of hemodialysis, blood calcium, bicarbonate, hemoglobin, hematocrit, blood alkaline phosphatase, renal function, level of plasma albumin and incidence of itchy skin, low back pain and left ventricular hypertrophy between the two groups were all compared and analyzed. Results： Two groups of patients in basic information including protopathy, age （43.2± 9.8 years vs. 40.5± 12.2 years）, sex ratio（16/12 vs.17/13）, duration of hemodialysis （32.56± 6.71 month vs.35.43± 5.82 month） were no significant difference （P〉0.05）. There were significant difference between case group and control group on the hemoglobin （83.22± 6.71g/L vs. 103.36± 5.84g/L）, hematocrit （24.83±1.92% vs. 30.76± 1.52%）, blood calcium （1.71± 0.16mmol/L vs. 2.23± 0.21 mmol/L）, bicarbonate （14.2± 3.1mmol/L vs. 20.6±4.9 retool/L）, blood alkaline phosphatase （124.26± 16.33U/L vs. 61.47± 14.91 U/L）, incidence of itchy skin （22/28 vs. 7/30）, low back pain （19/28 vs. 6/30）, and left ventricular hypertrophy （20/28 vs. 12/30）（P〈0.05）, but the creatinine （956±142mmol/L vs. 923± 156 mmol/L）, urea nitrogen （23.1 ± 6.3mmol/L vs. 24.8± 8.9 mmol/L）, plasma albumin （30.5± 3.8g/L vs. 31.2± 2.9g/L） were not statistically significant （P〉0.05）. Conclusions： Compared with patients with normal serum phosphorus, maintenance hemodialysis patients with hyperphosphatemia has higher blood alkaline phosphatase, incidence of itchy skin, low back pain and left ventricular hypertrophy, and lower blood calcium, bicarbonate, hemoglobin, hematocrit. Words：