老年维持性血液透析患者矿物质代谢相关影响因素分析

Study on the related factors for mineral metabolism in elderly patients with maintenance hemodialysis

目的探讨老年维持性血液透析（MHD）患者矿物质代谢现况及相关影响因素，以提高本地区老年MHD患者生活质量和生存率。方法收集2012年1月至2013年8月新乡往电医4家综合医院466例MHD治疗3个月及以上患者的临床资料，按年龄将其分为老年组（年龄≥60岁）159例和非老年组（年龄〈60岁）307例。检测所有患者的血清钙离子、磷、全段甲状旁腺激素（iPTH）及碱性磷酸酶（ALP）等矿物质代谢的评估指标。分析老年MHD患者矿物质代谢现况及其与贫血：透析龄、透析充分性、营养不良及炎症因子等因素的关系。结果466例患者中，血钙（1．95±0．34）mmol／L，血磷（2．54±1．38）mmol／L，iPTH（409．5±345．6）ng／L；钙、磷和iPTH达标率分别为34．3％、20．4％和25．5Voo，每周透析3次患者的钙、磷和iPTH达标率分别’为50．8％、31．重％和32．2％。老年组患者血磷、iPTH、ALP、白蛋白、转铁蛋白饱和度低于非老年组（均P〈0．01），前白蛋白、血红蛋白、铁蛋白亦低于非老年组（均P〈0．05）；而血钙、C反应蛋白明显高于非老年组（均P〈0．05）。结论老年MHD患者矿物质代谢异常有其独特的临床变化，主要表现为低转运骨病，存在微炎症、营养不良，且贫血较非老年MHD患者更为严重。

Objective To investigate the present state of mineral metabolism and its related factors in elderly patients with maintenance hemodialysis （MHD）, in order to improve the quality of life and survival rate in elderly patients with MHD in Xinxiang. Methods Clinical data of 466 patients with treatment of MHD for over 3 months in 4 hospitals in Xinxiang distxict were enrolled from January 2012 to August 2013 in this study, and the patients were divided into the elderly group （n=159, aged ≥60 years） and the non-elderly group （n= 307, aged〈60 years）. The evaluation indexes for mineral metabolism were determinated, such as serum levels of calcium, phosphorus, intact parathyroid hormone （iPTH） and alkaline phosphatase （ALP）. The present state of mineral metabolism and its relationships with anemia, dialysis ages, adequacy of dialysis, malnutrition and inflammatory factors were analyzed in elderly patients with MHD. Results Among 466 patients, the serum levels of calcium, phosphorus and iPTH in MHD patients were （1. 95±0. 34） retool/L, （2.54±1.38） mmol/L and （409.5±345.6） ng/L respectively, and their control rates were 34.3%, 20.4% and 25.5% respectively. And in patients with hemodialysis three times a week, the control rates were 50.8%, 31.4% and 32.2% respectively. The serum levels of phosphorus, iPTH, ALP, albumin and transferrin saturation were lower in elderly group than in non-elderly group （all P〈0.01）, and the serum levels of pre-alhumin, hemoglobin and feritin were lower in elderly group than in non-elderly group （all P〈0.05）. But the serum levels of calcium and C-reactive protein （CRP） were higher in elderly group than in non-elderly group （all P〈0.05）. Conclusions The elderly patients with MHD exhibit unique clinical manifestations of abnormal mineral metabolism, and low bone transformation osteopathy is the main manifestation. The micro-inflammation, malnutrition and anemia are more severe in elderly patients than in non-elderly patients.