慢性肾脏病透析患者继发转移性钙化的临床相关因素

Clinical relevant factors of secondary metastatic calcification in chronic kidney disease patients after dialysis

目的分析慢性肾病透析后继发性甲状旁腺功能亢进性骨病患者转移性钙化的临床相关因素。方法回顾性分析36例临床确诊为终末期肾病继发甲状旁腺功能亢进性骨病合并转移性钙化患者的资料,透析时间<10年者19例(短期透析组),透析时间≥10年者17例(长期透析组)。计算并比较两组患者转移性钙化发生率,采用简单相关分析检验转移性钙化与透析时间、血钙、血磷、钙磷乘积和血全段甲状旁腺素(iPTH)的相关性。绘制ROC曲线评价透析时间、血钙、血磷、血iPTH预测转移性钙化的效能。结果短期透析组软组织钙化[15.26%(29/190)]和血管钙化发生率[22.11%(42/190)]均低于长期透析组[22.35%(38/170)、31.76%(54/170),P均<0.05]。软组织钙化数、血管钙化数及钙化总数短期透析组中与透析时间呈正相关(r=0.49、0.40、0.53,P均<0.05),长期透析组中与透析时间无相关性(P>0.05),两组中软组织钙化数、血管钙化数及钙化总数与血钙、血磷、钙磷乘积、血iPTH均无明显相关性(P均>0.05)。透析时间和血iPTH预测转移性钙化效能较高,ROC曲线下面积(AUC)为0.97和0.88(P均<0.05),血钙和血磷预测转移性钙化效能较低,AUC分别为0.67和0.48(P均>0.05)。结论终末期肾病患者中透析时间是影响继发性甲状旁腺功能亢进性骨病转移性钙化重要因素。

Objective To explore the clinical relevant factors of metastatic calcification in patients of chronic kidney disease complicated secondary hyperparathyroidism bone disease after dialysis. Methods Data of 36 patients of chronic kidney disease complicated with secondary hyperparathyroidism bone disease with metastatic calcification were retrospectively ana- lyzed. There were 19 patients receiving dialysis for ≥10 years （short-term dialysis group） and 17 patients for ≥10 years （long-term dialysis group）. The incidence of metastatic calcification were calculated and compared between the two groups. Simple correlation analysis was used to evaluate correlation of metastatic calcification and clinical factors such as dialysis time, blood calcium, blood phosphorus, calcium-phosphorus product and blood intact parathyroid hormone （iPTH）. ROC curve was drawn to assess the ability of dialysis time, blood calcium, blood phosphorus and blood intact parathyroid in predicting metastatic calcification. Results The calcification incidence of soft tissue （15.26% [29/190]） and vascular （22.11% [42/190-]） in short-term dialysis group were both statistically lower than those in long-term dialysis group （22.35% [38/170] and 31.76% [54/170], both P〈0.05）. The number of soft tissue calcification, vascular calcification and the total number of calcification were all positively correlated with dialysis time in short-term dialysis group （r= 0.49, 0.40, 0. 53, all P〈0.05） and were not correlated with dialysis time in long-term dialysis group （all P〈0.05）. The number of soft tissue calcification, vascular calcification and the total number of calcification was no correlation with blood calcium, blood phosphorus, calcium-phosphorus product and blood iPTH in both two groups （all P〈0. 05）. The ability of dialysis time and blood iPTH was high in predicting metastatic calcification with area under ROC curve （AUC） of 0.97 and 0.88 （both P〈0.05）, while the ability of blood calcium and blood phosphorus was not high with AUC of 0.67 and 0.48 （both P〈0.05）. Conclusion Dialysis time is an important factor of metastatic calcification in patients of end-stage renal disease complicated with secondary hyperparathyroidism bone disease.