成年血液透析患者矿物质及骨代谢紊乱调查

Survey of CKD-MBD in adult patients with hemodialysis

目的 调查江苏省昆山市第一人民医院维持性血液透析（maintenance hemodialysis,MHD）患者的慢性肾脏病矿物质及骨代谢异常（chronic kidney disease-mineral and bone disorders,CKD-MBD）情况,比较分析老年和非老年患者CKD-MBD的特点,为临床治疗提供依据.方法 调查234例MHD患者的透析龄、透前肌酐、血小板、白蛋白、血色素、血钙、血磷、ALP及iPTH的水平及临床资料,与指南比较分析老年组和非老年组血钙、血磷、ALP及iPTH的特点.结果 我院MHD患者非老年组患病率高于老年组（P＜0.05）;透析龄、干体重、透前肌酐、白蛋白水平等指标两组间差异无统计学意义（P＞0.05）;血清钙、磷、iPTH达标率分别为83.76％、19.66％、40.17％.两组比较,老年组血清钙、磷、iPTH、ALP均不同程度的低于非老年组,差异有统计学意义（P＜0.05）.结论 老年组MHD患者CKD-MBD指标低于非老年组,提示两组患者CKD-MBD发生机制存在差异,老年患者容易合并低转运骨病（akinesis bone disease,ABD）.

Objective To analyze the prevalence of disorders of calcium and phosphorus metabolism and iPTH in elderly （≥ 65 years old） and non-elderly （＜ 65 year old） maintenance hemodialysis （MHD） patients.Methods We invstigated 234 MHD patients treated in the hemodialysis centre and analyzed years for dialysis,dry weight,Scr before hemodialysis,platelet （PLT）,albumin （Alb）,hemoglobin （Hb）、serum Ca,serum phosphate,intact parathyroid hormone （iPTH）,and alkaline phosphatase （ALP） in elderly and non-elderly MHD patients.We also compared these data with the guidelines and observed the differencs between the two groups.Results The prevalance rate of CKD in nonelderly patients is higher than that in elderly patients （P＜0.05）.There is no significant difference in years for dialysis,dry weight,Scr before hemodialysis,PLT and Alb between the two groups （P＞0.05）.The overall proficiency of serum calcium,serum phosphorus and iPTH was 83.76％,19.66％,40.17％,respectively.Moreover,the proficiency of calcium,phosphorus and iPTH in the elderly MHD patients were significantly lower than those in non-elderly patients （P ＜ 0.05）.Conclusion The disorder of serum phosphorus metabolism in the elderly MHD patients is significantly different from that in non-elderly patients,which indicates that the distinct pathogenesis of CKD-MBD in elderly MHD patients.The elderly patients may be suffered from ABD more easily.