血液透析患者动静脉内瘘血管壁改变与钙磷代谢的相关性研究

The relationship between thickness of artery wall in AVF and calcium-phosphorus metabolism

目的探讨维持性血液透析患者动静脉内瘘血管壁改变与钙磷代谢和甲状旁腺激素(PTH)的相关性,为临床血液透析患者钙磷代谢紊乱的调节提供依据。方法纳入2013年1月至2015年12月于我院住院行动静脉内瘘手术的维持性血液透析患者共32例,收集所有患者的基本资料及实验室检查结果,包括性别、年龄、原发病、透析年龄、总胆固醇(CHOL)、HDL、LDL、TG、ALB、钙、磷、PTH的检测结果。所有患者在手术中留取少许动静脉内瘘动脉端血管标本进行分析。根据患者血清PTH的水平将其分为甲组(PTH<400pg/ml)和乙组(PTH≥400pg/ml),比较两组患者血管壁的厚度及血清钙磷代谢情况。结果乙组患者血管内膜的厚度(IT)大于甲组患者,差异具有统计学意义(37.8±14.8vs.60.2±24.1,P=0.003)。乙组患者发生血管内膜厚度≥60μm的风险是甲组的8倍(CI:12.7~62.61,P<0.005),两组患者血管钙化情况比较差异无统计学意义(P=0.862)。回归分析提示PTH水平是患者血管壁增厚的独立危险因素(r=0.653,P<0.05)。结论维持性血液透析患者血管厚度与血清PTH水平密切相关,高PTH是患者血管损伤的独立危险因素。

Objective To investigate the relationship between thickness of artery wall in AVF and calcium-phosphorus metabolism,and provides the basis for the regulation of calcium phosphorus metabolism disorder. Methods 32 patients undergoing Av fistula formation were hospitalized between January 2013 and December 2015 in the Department of Nephrology of West China Hospital of Sichuan University. Baseline characteristics and results of laboratory studies, including sex, age, dialysis duration, causes of ESRD, the values of serum cholesterol （CHOL）,high density lipoprotein cholesterol（HDL）, low-density lipoprotein （LDL） cholesterol, triglyceride （TG）, albumin （ALB）, calcium, phosphate, hemoglobin（HGB）, and parathormone （PTH） were documented. The specimens of the arterial wall were obtained during the procedure and analyzed. Patients were divided into PTH ~400 （Group A） and PTH≥400 （Group B）. Results Mean intimal thickness （IT） was significantly high in patients of Group B （60.2± 24.1 μm）, compared with that of Group A （37.8±14.8 9m） （P=0. 003）. Patients with high （≥400 pg/mL） iPTH had 8 times the risk of developing in- ritual thickness of ≥60 μm, compared with patients with low （G400 pg/mL） PTH （P-value G0.05）, with 95% confidence interval of 12.7, 62.61. The PTH level was found to be an independent risk factor for high intima thickness （correlation coefficient 0. 653） （P-value G0.01）. Conclusion The thickness of artery wall in AVF is closelyrelated to the level of serum PTH in maintenance hemodialysis patients. The high PTH level is an independent risk factor for vascu- lar injury.