老年透析患者矿物质骨代谢紊乱的临床特征

Clinical analysis of mineral and bone disease pattern in elderly hemodialysis patients

目的研究老年透析患者矿物质骨代谢紊乱的临床特征。方法横断面研究:将符合入选标准维持性血液透析患者109例根据年龄分为老年组46例(年龄≥65岁,中位数72岁)及非老年组63例(年龄<65岁,中位数50岁)。记录一般资料,血白蛋白(ALB)、血钙(Ca)、磷(P)、全段甲状旁腺激素(i PTH)等实验室指标;评估尿素清除率(URR)及尿素清除指数(Kt/V)。比较2组患者上述指标差异。结果老年患者导致ESRD病因主要为肾小球肾炎、糖尿病肾病和高血压肾损害,非老年患者主要为肾小球肾炎,肾移植术后移植肾无功能及间质性肾损害。老年患者合并心血管疾病比例高于非老年患者(89.13%vs.46.03%;χ2=21.493,P=0.000)。老年组患者较非老年组患者血磷[(1.65±0.52)mmol/L vs.(2.03±0.65)mmol/L;t=3.270,P=0.001]、i PTH[135.00 pg/ml(49.40 pg/ml^279.50 pg/ml)vs.246.30 pg/ml(78.90 pg/ml^785.60 pg/ml);Z=-2.041,P=0.041]、碱性磷酸酶(74.50 U/L(60.75 U/L^74.50 U/L)vs.91.00U/L(69.00 U/L^135.00 U/L);Z=-2.7777,P=0.005)、血清白蛋白(37.23±3.23)g/L vs.(38.93±2.78)g/L;t=2.933,P=0.004)及三酰甘油[(1.49±0.79)mmol/L vs.(1.87±0.92)mmol/L;t=2.260,P=0.026]水平低,但是血钙、血红蛋白及透析相关指标(干体质量、透析时间、URR、Kt/V)无统计学差异。老年组患者应用活性维生素D的人群比例(39.13%vs.68.25%;χ2=9.150,P=0.002)以及应用维生素D人群中处方剂量[0.50μg/d(0.25μg/d^0.50μg/d)vs.0.50 Mg/d(0.50μg/d^1.00μg/d);Z=-3.544,P=0.000]均低于非老年组。结论老年透析患者血磷、钙磷乘积、全段甲状旁腺素和碱性磷酸酶水平低于非老年组患者,血钙水平无差异。

Objective To analyze the clinical characteristics of mineral and bone disease pattern in elderly hemodialysis patients. Materials and Methods This cross-sectional study was based on clinical records of 109 maintenance hemodialysis patients. They were divided into two groups by age： elderly group （age 〉65, median age =72 years, n=46） and non-elderly group （age 〈65, median age =50 years, n=63）. Serum phosphoms, calcium, parathyroid hormone （PTH）, albumin, and C-reactive protein were measured. Urea clearance rate （URR） and Kt/V were calculated. These parameters were compared between the two groups. Results Elderly patients exhibited lower serum phosphorus （1.65＋0.52 mmol/L vs. 2.03＋0.65 mmol/L; t=3.270, P=- 0.001）, serum alkaline phosphatase [74.50 （60.75-74.50） U/L vs. 91.00 （69.00- 135.00） U/L; Z=-2.7777, P=- 0.005] and parathyroid hormone [74.50（60.75-74.50） pg/ml vs. 91.00 （69.00- 135.00） pg/ml; Z=-2.7777, P=- 0.005） as compared with those in the non-elderly group. However, serum calcium, hemoglobin, URR, Kt/V, dry body weight and hemodialysis age were similar between the two groups. Elderly patients also had lower serum albumin （37.23-3.23 g/1 vs. 38.934-2.78 g/l; t=2.933, P=0.004） and serum triglyceride （1.49＋0.79 mmol/ L vs. 1.87-0.92 mmol/1; t=-2.260, P=0.026）, and less a Cctive vitamin D derivatives usage （39.13% vs. 68.25%; %2=9.150, P=0.002） and active vitamin D dosage [0.50 （0.25-0.50） μg/d vs. 0.50 （0.50- 1.00） μg/d; Z =- 3.544, P=-0.000）. Conclusions Serum phosphorus, iPTH and alkaline phosphatase levels were lower in elderly hemodialysis group than in non-elderly hemodialysis group. But serum calcium was similar between the two groups.