维持性透析患儿钙磷代谢和甲状旁腺功能的变化

Changes of calcium-phosphorus metabolism and parathyroid function in maintenance hemodialysis children

目的探讨维持性血液透析(MHD)患儿钙磷代谢和甲状旁腺功能的变化。方法观察首都医科大学附属北京儿童医院肾内科血液净化中心行MHD的19例终末期肾脏病患儿,记录透析前及透析3月后钙、磷、碱性磷酸酶及全段甲状旁腺激素(iPTH)水平,根据改善全球肾脏病预后国际组织指南标准进行比较,分析透析患儿钙磷代谢的达标率。结果 19例MHD患儿透析前高磷血症16例(84.21%);低钙血症17例(89.47%);碱性磷酸酶增高11例(57.69%);血iPTH高于600pg/ml的13例(66.42%)。透析3月后血磷(1.83±0.76)mmol/L、血钙(2.27±0.26)mmol/L、碱性磷酸酶(401.63±315.61)U/L及iPTH(675.97±581.66)ng/L,达标率分别为10例(52.63%)、15例(78.95%)、5例(26.32%)及10例(52.63%)。透析3月后与透析前比较,碱性磷酸酶无统计学意义(t=-1.497,P>0.05),血磷、血iPTH水平明显下降(分别为t=3.477,P<0.01;t=2.397,P<0.05),血钙水平明显升高(t=-7.392,P<0.01)。结论 MHD患儿普遍存在钙磷代谢紊乱和甲状旁腺功能异常,应当予以重视。通过本组研究发现,应用MHD联合血液透析滤过方案可以改善钙磷代谢紊乱。儿童碱性磷酸酶是否可以作为钙磷代谢紊乱的观察指标尚需进一步研究。

Objective To investigate the changes of serum calcium-phosphorus metabolism and parathyroid function in maintenance hemodialysis （MHD） children.Methods A total of 19 MHD children treated in our blood purification center were enrolled in this study.Serum calcium,phosphate and intact parathyroid hormone （iPTH） were measured before and after MHD for 3 months.Results Before MHD,hyperphosphatemia was found in 16 patients （84.21％）,hypocalcemia in 17 patients （89.47％）,elevated alkaline phosphatase in 11 patients （57.69％）,and iPTH level ＞600 pg/ml in 13 patients （66.42％）.After MHD for 3 months,the mean level of serum phosphorus,calcium,alkaline phosphatase,and iPTH was 1.83±0.76 mmol/L,2.27±0.26 mmol/ L,401.63±315.61 U/L,and 675.97±581.66 ng/L,respectively,approaching the target level of serum phosphorus,calcium,alkaline phosphatase,and iPTH in 10 patients （52.63％）,15 patients （78.95％）,5 patients （26.32％）,and 10 patients （52.63％）,respectively.While serum alkaline phosphatase changed insignificantly （t =-1.497,P＞0.05）,serum phosphorus and iPTH decreased （t =3.477,P＜0.01,and t =2.397,P＜0.05,respectively） and serum calcium increased （t =-7.392,P＜0.01） after MHD for 3 months as compared to those before MHD.Conclusions MHD children are frequently complicated with calcium-phosphorus metabolic derangements and secondary hyperparathyroidism,which should be carefully monitored.MHD combined with hemodiafiltration may be more effective to improve these derangements.Whether alkaline phosphatase can be used as the indicator for calcium-phosphorus metabolic changes in children needs to be further studied.