维持性血液透析患者甲状旁腺功能异常的相关因素分析

Analysis of correlated factors on maintenance hemodialysis patients with parathyroid dysfunction

目的对维持性血液透析(maintenance hemodialysis,MHD)患者甲状旁腺功能异常的相关因素进行分析,并进一步分析MHD患者甲状旁腺素(parathyroid hormone,PTH)水平异常的独立危险因素。方法选择2015年6月至2015年12月在武汉大学中南医院血液净化中心进行MHD治疗的患者共85例,将85例患者根据全段甲状旁腺素(intact parathyroid hormone,iPTH)水平分为PTH减低组(iPTH水平<150 ng/L)、PTH正常组(iPTH水平为150~300 ng/L)、PTH升高组(iPTH水平>300 ng/L);采用Hamilton抑郁量表(24项版)评估患者抑郁状况;比较各组患者年龄、透析时间、糖尿病患病率、抑郁患病率、体质量指数(body mass index,BMI)及血生化等指标,采用多元线性回归方程分析iPTH与上述指标的相关性;采用多因素Logistic回归法分析iPTH水平异常的危险因素。结果与PTH正常组比较,PTH减低组血钙水平更低(P<0.05),糖尿病患病率、抑郁患病率升高(P<0.05);PTH升高组血红蛋白降低(P<0.05),年龄、血肌酐值升高(P<0.05);PTH减低组、PTH升高组血清铁、转铁蛋白饱和度均较PTH正常组降低(P<0.05)。3组患者透析时间、C反应蛋白、红细胞比容、铁蛋白、总铁结合力、血磷差异无统计学意义(P>0.05);多元线性回归分析显示,iPTH与BMI、年龄呈正相关(r=0.040,0.051),与血红蛋白、糖尿病呈负相关(r=-0.331,-0.357)。Logistic回归分析显示,糖尿病为iPTH减低的独立危险因素,BMI、血肌酐为iPTH升高的独立危险因素。结论 MHD患者PTH水平与BMI、年龄呈正相关,与血红蛋白、糖尿病呈负相关。糖尿病、BMI、血肌酐为PTH水平异常的独立危险因素。

Objective To analyze the related factors on the maintenance hemodialysis patients with parathyroid dysfunction, and further analyzed the independent risk factors of abnormal parathy- roid hormone in MHD patients. Methods 85 patients were divided into PTH reduced group（iPTH〈 150 ng/L）, PTH normal group（150 ng/L≤iPTH≤300 ng/L） and PTH increased group（iPTH〉300 ng/L） according to the levels of intact parathyroid hormone. Hamilton depression scale（HAMD 24 items） was adopted to evaluate depression status of patients. The indicators of age, dialysis age, mor- bidity of diabetes, prevalence of depression, body mass index（BMI） and serum biochemical variables were compared in this study. Multiple linear regression was used to analyze the correlation of iPTH and the above indicators. Moreover, multifactor logistic regression was also employed to analyze the risk factors on iPTH levels abnormity. Results Compared with PTH normal group, serum calcium levels were lower（P〈0. 05） and the diabetes morbidity rate and depression morbidity rate were higher in the PTH reduced group（P〈0. 05）, the hemoglobin was lower, age and serum creatinine level were higher in the PTH increased group. The serum iron and transferrin saturation of PTH reduced groupand PTH increased group were lower in comparison with PTH normal group. Dialysis age, C-reactive protein, hematocrit, ferritin total iron binding force and serum phosphorus of the three groups showed no statistical significance（P〈0. 05）. The result of multiple logistic linear regression showed that the iPTH was positively correlated with BMI and age（r = 0. 040, 0. 051）, and negatively correlated with hemoglobin and diabetes（r = -0. 039, -0. 357）. The logistic linear regression showed that diabetes was the independent risk factors for reduced iPTH, and BMI, serum creatinine were the independent risk factors for increased iPTH. Conclusions The iPTH level in MHD patients was positively correla- ted with BMI and age, and negatively correlated with hemoglobin and diabetes. Diabetes, BMI and se- rum creatinine were independent risk factors of the abnormal level of PTH.