Sagliker综合征相关危险因素分析

Analysis of risk factors related to patients with Sagliker syndrome

目的初步探讨重症肾性继发性甲状旁腺功能亢进（ secondary hyperparathyroidism, SHPT）合并Sagliker综合征（Sagliker syndrome，SS）的临床特点和相关危险因素。方法纳入2011年2月至2015年4月在安徽医科大学第二附属医院肾脏内科确诊重症。肾性SHPT患者229例，其中SS组33例，余196例为对照组。比较两组患者在年龄、性别等人口学资料、并发症及血清学指标方面的差异，分析导致SS可能的危险因素。结果SS组患者中位透析龄为11年，显著长于对照组（8年），差异有统计学意义（P〈0．001）；与对照组比较，SS组患者血肌酐、血尿素氮、白蛋白、血磷水平较低，而全段甲状旁腺激素（iPTH）、铁蛋白、超敏C反应蛋白、碱性磷酸酶（ALP）、心瓣膜及腹主动脉钙化比例较高，差异均有统计学意义（均P〈0．05）；单因素Logistic回归分析结果显示，长透析龄（〉10年，OR=6．182，P=0．002）、高ALP（〉347U／L，OR=5．786，P=0．002）、高iPTH（〉1764ng／L，OR=4．960，P=0.001）、心瓣膜及腹主动脉钙化（OR=8．635，P〈0．001；OR=5．039，P=0．001）均是发生SS的危险因素，高血清白蛋白是SS的保护因素（OR=0．904，P=0．014）；多因素回归分析结果显示，长透析龄（〉10年，OR=5．121，P=0．036）、高iPTH（〉1764ng／L，OR=4．130，P=0．017）、心瓣膜钙化（OR=11．714，P〈0．001）是SS的独立危险因素。结论长透析龄及高iPTH是重症SHPT患者发生SS的独立危险因素。

Objective To explore the clinical characteristics and related risk factors in patients with severe uremic secondary hyperparathyroidism （SHPT） complicated with Sagliker syndrome （SS）. Methods A total of 229 patients with severe uremic SHPT admitted in our hospital from February 2011 to April 2015 were enrolled, among which 33 cases were taken as positive group （SS group）, and 196 cases as control group. The differences between two groups in demographic data （such as gender and age）, complications, and biochemical indexes were compared, with potential risk factors of SS being analyzed. Results There were significant differences between median duration of dialysis in positive group （11 years） and that in control group （8 years, P 〈 0.001）. Compared to control group, the patients in SS group had lower levels of serum creatinine （Scr）, blood urea nitrogen （BUN）, albumin （Alb）, phosphorus （P）, and higher serum levels of parathyroid hormone （iPTH）, ferritin, hypersensitive C- reactive protein and alkaline phosphatase （ALP）, as well as higher calcification in heart valves and abdominal aortic （all P 〈 0.05）. The unadjusted logistic regression models showed that longer duration of dialysis （ 〉 10 years, OR=6.182, P=0.002）, higher serum levels of ALP （ 〉 347 U/L, OR=5.786, P=0.002） and iPTH （〉 1764 ng/L, OR=4.960, P=0.001）, and calcification in heart valves and abdominal aortic （OR=8.635, P 〈 0.001; OR=5.039, P=0.001） were associated with increased risks of SS, and higher serum Alb was a protect factor for SS （OR=0.904, P=0.014）. The multivariate regression analysis showed that longer duration of dialysis （〉 10 years, OR=5.121, P=0.036）, higher serum level of iPTH （〉 1764 ng/L, OR=4.130, P=0.017）, calcification in heart valves （OR=1 1.714, P 〈 0.001） were independent risk factors of SS. Conclusions Severe uremic SHPT patients with longer duration of dialysis and higher serum level of iPTH are more likely to develop SS.