不同全段甲状旁腺激素水平对维持性血液透析患者临床指标影响及相关因素分析

The influence of serum intact parathyroid levels on clinical variables and its related factors in patients undergoing maintenance hemodialysis

目的探讨不同全段甲状旁腺激素(intact parathyroid hormone,iPTH)水平对维持性血液透析(maintenance hemodialysis,MHD)患者临床指标的影响,并进行相关因素分析。方法选取HD患者共93例,测定iPTH及血生化指标,根据血iPTH水平分为A组iPTH<150pg/ml,B组iPTH150～300pg/ml,C组iPTH>300pg/ml,比较3组年龄、糖尿病患病率、透析龄、体质量、体质量指数及血生化等临床指标,采用多元线性回归分析血iPTH与年龄、性别、糖尿病、透析龄、血校正钙、血磷、血碱性磷酸酶的相关性。结果 A组相比,B、C组的年龄、肌酐和血磷水平均显著升高(P<0.05);A组的糖尿病患病率最高,B组和C组依次减少,差异有统计学意义(÷2=11.393,P=0.03);3组的iPTH、透析龄、血校正钙及ALP水平相比,差异有统计学意义(F=81.619,28.589,6.129,7.384;P=0.000,0.000,0.042,0.025),C组最高,其中B组与A组的iPTH及透析龄依次降低;多元线性回归分析表明,iPTH的平方根即Sqrt(iPTH)与透析龄(回归系数0.102)及血磷(回归系数3.077)成正相关,与糖尿病(回归系数-1.294)成负相关。结论 iPTH水平可影响MHD患者的预后;iPTH与透析龄、血磷呈正相关,与糖尿病呈负相关。

Objective To investigate and analyze the influence of serum intact parathyroid hormone （iPTH） levels on biochemical variables and its related factors in patients undergoing maintenance hemodialysis （MHD）. Methods Ninety-three CKD patients on MHD were divided into 3 groups based on serum iPTH level （group A, iPTH 〈 150 pg/m; group B, iPTH 150-300 pg/ml; group C, iPTH 〉 300 pg/ ml）. Age, prevalence of diabetes, duration on dialysis, body weight, BMI, and serum biochemical variables were compared among the 3 groups. Multiple linear regression was used to disclose the relationship between serum iPTH and the variables of age, gender, diabetes mellitus, duration on dialysis, serum calcium （Ca）, phosphorus （P）, and alkaline phosphates （ALP）. Results Age, serum creatinine and P were significantly higher in group B and C than in group A （P 〈 0.05）. The diabetes morbidity was higher in group A, lower in group B, and lowest in group C （χ^2=1 1.393, P=-0.03）. Serum iPTH, Ca, ALP and duration on dialysis were compared among the three groups, and the remarkable differences were found （F=81.619, 28.589, 6.129, and 7.384, respectively; P=0.000, 0.000, 0.042, and 0.025, respectively）. Serum iPTH, Ca, ALP and duration on dialysis were higher in group C, lower in group B, and lowest in group A. Multiple linear regression demonstrated that the square root of iPTH value was positively correlated with duration on dialysis （b=0. 102） and serum P （b=3.077）, and was negatively correlated with diabetes mellitus （b=-1.294）. Conclusions Serum iPTH level affected the prognosis of MHD patients. This level was positively correlated with duration on dialysis and serum P, and negatively correlated with diabetes.