腹膜透析患者发生难治性甲状旁腺功能亢进的相关因素分析

Risk factor analysis of refractory secondary hyperparathyroidism in patients undergoing continuous ambulatory peritoneal dialysis

目的:探讨引起腹膜透析患者的难治性甲状旁腺功能亢进(SHPT)的相关因素。方法:分析2015年11月～2018年5月于我院行甲状旁腺切除术的51例腹膜透析患者临床资料,并与我院同期50例甲状旁腺激素<300pg/ml的腹膜透析患者进行比较,对发生难治性SHPT的相关因素:血钙、血磷、血白蛋白及透析龄、透析液种类、合并糖尿病情况以及开始检测iPTH的时间等进行逻辑回归分析。结果:2组血钙、血磷、透析龄、血白蛋白、开始检测iPTH的时间均存在显著性差异(P<0.01,P<0.05)。行手术的难治性甲状旁腺功能亢进组患者开始检测iPTH的时间,明显晚于甲状旁腺激素在300pg/ml以下的腹膜透析患者(P<0.01)。回归分析显示,透析龄长、高血磷、开始检测iPTH时间等均是腹膜透析患者发生难治性SHPT的风险因素。结论:腹膜透析患者高透析龄、高血磷、开始检测iPTH晚等是其发展为难治性SHPT的风险因素。

Objective:To investigate the risk factors of refractory secondary hyperparathyroidism (SHPT)in patients with continuous ambulatory peritoneal dialysis (CAPD).Methods:The study enrolled 101patients with CAPD,fifty-one cases of whom were diagnosed as refractory SHPT and underwent parathyroidectomy in recent two and a half years in our hospital.The other 50cases were CAPD patients in our hospital,whose intact parathyroid hormone (iPTH)were well controlled (lower than 300pg/ml).Logistic regression analysis was performed on the clinical data of two groups to analyze the influence factors of refractory SHPT in CAPD patients.Results :There were significant differences in the levels of serum calcium,phosphorus,dialysis vintage and serum albumin between the two groups (P<0.01,P<0.05).The use ratio of low-calcium peritoneal dialysis solution,the time to start iPTH testing were significantly different between the two groups(P<0.01).Logistic regression analysis showed that the dialysis vintage,blood phosphate and the time of start iPTH testing were influence factors of refractory SHPT in CAPD patients.Conclusion:High dialysis vintage,high blood phosphate level and late detection of iPTH may be the risk factors for developing refractory SHPT in CAPD patients.