维持性血液透析患者高磷血症临床分析

Clinical analysis of hyperphosphataemia in patients with maintenance hemodialysis

目的了解维持性血液透析患者高磷血症的临床特点，提高透析患者生活质量。方法选取2009年6月1日和6月2日在我院血液透析中心接受维持性血液透析且透析时间超过3个月的患者118例。根据基线血磷水平将患者分为高磷组（71例，血磷≥1．78mmol／L）和对照组（47例，血磷〈1．78mmol／L）。随访观察2年，探讨血磷水平与透析患者心脏结构和功能的关系。结果高磷组与对照组的性别、年龄及透析通路等比较差异有统计学意义（P〈0．05），而透析方式、透析龄、透析间期每日尿量、透析器面积、透析血流量等比较差异无统计学意义（P〉0．05）。两组患者在透析前血清肌酐、尿素氮、尿酸、总二氧化碳、全段甲状旁腺激素、白蛋白、总胆固醇、三酰甘油、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇等比较差异有统计学意义（P均〈0．05），但两组患者血钙和血红蛋白水平比较差异无统计学意义（P〉0．05）。心脏彩超检查显示高磷组患者左心室后壁、室间隔厚度、左心室舒张末期容积及心脏质量显著高于对照组，但两组射血分数及左心室收缩末期容积比较差异无统计学意义。随访2年，两组病死率比较差异无统计学意义（P〉0．05），但高磷组冠心病发生率显著高于对照组（35．2％和17．0％，P〈0．05）。结论患高磷血症的维持性血液透析患者往往存在透析不充分，其患冠心病的风险显著升高，充分透析、积极降低血磷水平能改善血透患者生活质量。

Objective To investigate the clinical characteristics and prognosis of hyperphospha- taemia in patients with maintenance hemodialysis（MH）. Methods 118 MH patients received dialysis for more than 3 months in June 1 rt -2nd,2009 were recruited. These patients were divided into two groups：hy- perphosphataemia group（baseline serum phosphate≥ 1.78 mmol/L, n = 71 ） and control group （serum phosphate 〈 1.78 mmol/L, n = 47 ）. Cardiac structural parameters were assessed by Doppler echocardio- graphy. The association between hyperphosphataemia and cardiac structural abnormality was analyzed. Re- suits There were no significant differences in modality, dialysis time ,urine volume during dialysis, dialy- zer membrane area and blood flow between hyperphosphataemia group and control group. However, be- tween these two groups, there were significant differences in gender, age and dialysis access. Also, there were significant differences in predialysis creatinine, urea nitrogen, uric acid, CO2, iPTH, plasma albumin, total cholesterol,triglyceride, low density lipoprotein cholesterol and high density lipoprotein cholesterol, but there were no significant differences in serum calcium and hemoglobin. About Doppler echocardio- graphy, 1 eft ventricular end-diastolic dimension, interventricular septum end-diastofic thickness, 1 eft ven- tricular posterior wall end-diastolic thickness and left ventricle mass index in hyperphosphataemia group were higher than those in control group, but there were no significant differences in calculated ejection fraction and 1 eft ventricular end- systolic dimension. After two years of follow-up, difference of mortality between these two groups was not significant, but the morbidity of coronary heart disease（CHD） in hyper- phosphataemia group was significantly higher than that in control group. Conclusion Hyperphosphatae- mia played an important role in dialysis adequacy in patients with maintenance hemodialysis. The morbidi- ty of CHD in hyperphosphataemia group was high. Adequate dialysis and therapy to reduce blood phos- phorus could increase life quality, prevent CHD and decrease cardiovascular events.