慢性HBV感染对腹膜透析患者钙磷代谢的影响

Effect of chronic hepatitis B infection on calcium-phosphorus metabolism in peritoneal dialysis patients

目的:评估持续性腹膜透析(CAPD)患者中慢性HBV的感染对钙磷代谢的影响。方法:选取2009年1月至2015年3月于我院住院治疗的CAPD患者85例,其中慢性HBV感染者33例,HBV阴性者52例。比较HBV感染组和对照组的血清矫正钙、磷、钙磷乘积(Ca×P)和iPTH水平及各指标达标率有无差异,并分析Ca×P和i PTH不达标的危险因素。结果:慢性HBV感染组的血磷、Ca×P较对照组显著升高,两组血清矫正钙、iPTH相比差异无统计学意义。HBV感染组矫正钙达标率(42.42%vs.67.31%,P<0.05)、Ca×P达标率(51.51%vs.80.77%,P<0.01)、iPTH达标率(48.48%vs.73.08%,P<0.05)显著低于对照组,血磷达标率(48.48%vs.50.00%,P>0.05)与对照组相比差异无统计学意义。多重线性回归分析显示慢性HBV感染与Ca×P呈正相关(B=11.515,P<0.01)。单自变量和多自变量的Logistic回归分析显示慢性HBV感染是Ca×P不达标(P<0.05)和iPTH不达标(P<0.05)的独立危险因素。结论:慢性HBV的感染可能是CAPD患者钙磷代谢异常的危险因素。

Objective To evaluate the effect of chronic HBV infection on calcium phosphorus metabolism in patients with continuous ambulatory peritoneal dialysis（CAPD）. Methods From January 2009 to March 2015, a total of 85 CAPD patients in our hospital were enrolled in the study, and 33 cases showed chronic HBV infection. Serum calcium, phosphorus, calcium and phosphorus product （Ca × P）, intact parathyroid hormone （iPTH） levels were compared in CAPD patients with or without chronic HBV infection, the risk factors of substandard Ca × P and substandard iPTH were also analyzed. Results There was no significant difference in serum calcium[adj] levels and iPTH levels between patients with or without chronic HBV infection. Phosphorus levels and Ca × P were significantly higher in patients with chronic HBV infection; Compared with patients in the control group, patients in the chronic HBV infection group also showed significantly lowered rate of Ca[adj] （42.42% vs. 67.31%, P 〈 0.05）, Ca × P （51.51% vs. 80.77%, P 〈 0.01） and iPTH （48.48% vs. 73.08%, P 〈 0.05）. According to the muhivariable linear regression analysis, the high level of Ca × P was related with chronic HBV infection （B = 11.515, P 〈 0.01） after adjustments for age, gender, iPTH and diabetes. Univariate and multivariate logistic regression analysis showed that chronic HBV infection was the risk factor for the substandard Ca × P （P 〈 0.05） and substandard iPTH （P 〈 0.05）. Conclusion Chronic HBV infection may increase the risk of abnorulal calcium phosphorus metabolism in CAPD patients.