慢性肾脏病3～4期患者骨矿物质代谢紊乱的调查

Investigation of mineral and bone metabolic disorders in patients with chronic kidney disease at stage 3 to 4

目的 调查慢性肾脏病（chronickidney disease,CKD）3 ～4期患者慢性肾脏病矿物质及骨代谢紊乱（chronic kidney disease-mineral and bone disorder,CKD-MBD）的状况和检测有关骨代谢的指标.方法 检测111例CKD3～4期患者的血钙、血磷、血清全段甲状旁腺素（intact parathyroid hormone,iPTH）,并随机对其中20例患者行25羟维生素D[25（OH）D]及骨性碱性磷酸酶（bone-alkaline phosphare,b-ALP）的检测.结果 CKD3 ～4期患者矫正钙分别为（2.25 ±0.12 mmol/L）和（2.20±0.14 mmol/L）,血磷分别为（1.20 ±0.23 mmol/L）和（1.36 ±0.28 mmol/L）,iPTH分别为（73.18±51.77pg/mL）和（118.95±64.97pg/mL）,低钙血症的发生率分别为2.22％和6.06％,高磷血症的发生率分别为0％和7.58％,SHPT的发生率分别为37.78％和48.48％.CKD4期患者与CKD3期的患者相比,血钙显著性下降（P＜0.05）,iPTH水平显著升高（P＜0.05）,iPTH水平与血磷（r=0.103,P＞0.05）成正相关,与GFR（r=-0.422,P＜0.01）、血钙（r=-0.268,P＜0.01）成负相关.多元逐步回归分析显示,血钙、血磷、GFR是iPTH的独立影响因素（复相关系数R=0.482,p＜0.05）.CKD3～4期患者b-ALP（74.476±56.056ng/mL）,显著高于健康人（24.141±14.741ng/mL）（P＜0.01）,而25（OH）D（173.763±52.375ng/mL）显著低于健康人（306.995±93.085ng/mL）（P＜0.05）.结论 CKD早期患者存在CKD-MBD及骨代谢异常,且随着疾病的进展而愈加明显,应重视并早期干预,从而改善预后.

Objectives To investigate the calcium-phosphate metabolic condition in patients at chronic kidney disease （CKD） stage3-4.Methods Compared the levels of phosphate,intact parathyroid hormone （iPTH）,bone-alkaline phosphatase （b-AlP） and 25 （OH） D of patients at CKD stages3-4.Results In CKD patients at stage 3and 4,serum calcium was （2.18 ± 0.14mmol/L） and （2.11 ± 0.17mmol/L）,respectively; serum phosphate was （1.20 ±0.23mmol/L） and （1.36 ±0.28mmol/L）,respectively; serum iPTH was （73.18 ±51.77pg/ml） and （118.95 ± 64.97 pg/ml）,respectively.The patients at stage 3 and 4,the prevalence of hypocalcemia was 2.22％ and 6.06％,respectively ; the prevalence of hyperphosphatemia was 0％ and 7.58％,respectively;the prevalence of SHPT was 37.78％ and 48.48％,respectively.With the progression of chronic kidney disease,serum calcium gradually decreased,intact parathyroid hormone （iPTH） increased.Serum iPTH level was negatively correlated with serum calcium and glomerular filtration rate （GFR）,and was positively correlated with serum phosphate.CKD patients at stage3and4,serum b-ALP was 74.476 ± 56.056 ng/ml,higher than the healthy individuals （24.141 ± 14.741 ng/ml） significantly （P ＜ 0.01）.On the contrary,the 25 （OH） D was 173.763 ± 52.375 ng/ml,much more lower than the healthy individuals （306.995 ± 93.085 ng/ml） （P ＜ 0.05）.Conclusions Metabolic disorders emerge early in CKD patients and deteriorate in association with the progression of CKD.Early intervention should be given to improve their outcomes.