188例维持性血液透析患者治疗情况和骨矿物质代谢横断面调查报告

Bone mineral metabolism in patients undergoing maintenance hemodialysis

目的了解和掌握维持性血液透析患者的情况以及矿物质和骨代谢紊乱的控制情况。方法选取维持性血液透析患者共188例,按照不同透析方式分为单纯低通量透析组113例和复合透析组75例,调查两组患者年龄、性别、原发疾病、透析年龄、透析频率,并检测矿物质代谢的指标,与透析预后及实践模式(DOPPS4)研究、国内同期调查研究作比较,分析血液透析患者矿物质代谢紊乱的控制情况及相关因素。结果原发病包括慢性肾小球肾炎82例(43.6%),糖尿病肾病50例(26.6%),高血压肾病32例(17.0%),其他病因24例(12.8%)。透析龄≥5年占26.8%,透析龄<5年占73.2%。两组患者中血磷及甲状旁腺激素水平的差异有统计学意义(P<0.01),其余各项两组间差异均无统计学意义(均P>0.05)。本透析中心患者的血磷、甲状旁腺激素的达标率与DOPPS4的研究结果比较差异无统计学意义(P>0.01);而本中心患者血钙的达标率(83.5%)明显高于DOPPS4的调查结果(56.0%),但甲状旁腺激素>300pg/ml占56.9%,稍高于国内多中心的调查结果的44.5%,远高于DOPPS4研究中的35.3%。同时,血钙、血磷达标率控制值明显高于国内的多中心调查结果。结论本中心透析老年透析患者比例较高;同时,本透析中心患者的矿物质代谢紊乱控制情况优于国内报道的透析中心同期水平,但与发达国家的DOPPS4研究结果仍然还有较大差距,需要进一步加强防治。

Objective To investigate bone mineral metabolism in patients undergoing maintenance hemodialysis （MHD）. Methods One hundred and eighty eight patients with a mean age of 63.7±14.1undergoing MHD were enrol ed in the study, including 82 cases with chronic glomerulonephritis（43.6%）, 50 cases with diabetic nephropathy（26.6%）, 32 cases with hy-pertensive nephropathy（17.0%） and 24 cases with other diseases （12.8%）. Among them 113 cases received pure low flux dialysis （60.1%） and 75 cases （39.9%） received composite dialysis （low flux dialysis and continuous high flux dialysis or hemodialysis fil-tration）. The duration of dialysis 5 y in 50 patients （26.8%） and the duration0.05）. The blood calcium control rate （83.5%） in our center was significantly higher than that of DOPPS4 （56.0%）. But the rate of patients with parathyroid hormone〉300pg/mL in our center was 56.9%, which was higher than that of domestic multicenter survey results （44.5%）, and much higher than that of DOPPS4（35.3%）. The blood calcium and phos-phorus control rates were significantly higher than those of domestic multicenter survey results. Conclusion The bone mineral metabolism control rate in patients undergoing maintenance dialysis in our center is better than that of domestic reported level, but stil lower than that of DOPPS4 results.