维持性血液透析患者血磷达标情况分析

Analysis of serum phosphorus achieved standard state in maintenance hemodialysis patients

目的通过分析昆明市第一人民医院血液净化中心维持性血液透析(maintenance hemodialysis,MHD)患者的临床数据,了解本中心的钙磷等达标情况及不同血磷水平的MHD患者营养状况和短期预后,以选择恰当的血磷干预方法。方法选取本中心MHD患者173例,每例患者每3个月测定血磷、血钙、全段甲状旁腺素(immunoreactive parathyroid hormone,iPTH)、白蛋白(albumin,Alb)、总胆固醇(total cholesterol,TC)、体质量指数(body mass index,BMI),至少测量6次,取其平均值。根据血磷测定值将MHD患者分为低磷组、标磷组、高磷组、超高磷组,使用T检验、卡方检验、秩和检验分析各组的病死率、部分营养指标、血总钙和iPTH、年龄、透析时间及透析频率,并用Logistic分析相关危险因素。结果本中心173例MHD患者相关指标的总体达标率分别为血磷42.2%、血钙67.6%、iPTH52.6%,钙磷乘积67.6%,Alb 43.4%,TC64.7%,BMI 60.7%;血磷、血钙、iPTH同时达标仅15.6%(27/173)。四组的病死率分析,标磷组最低(10.9%),低磷组最高(32.6%),但差异无统计学意义(P>0.05)。四组的血清Alb达标率:高磷组最高(55.6%),低磷组最低(15.8%),仅低磷组与标磷组(41.1%)比较差异有统计学意义(P<0.05)。高磷血症、营养不良和死亡相关因素分析:单因素Logistic分析年龄、血钙、血磷、iPTH、TC与病死率相关,有统计学意义(P<0.05)。多因素Logistic回归分析提示年龄、TC与病死率有统计学关联。结论 MHD患者钙磷代谢紊乱及营养不良发生率较高;单纯从营养状况和钙磷代谢情况观察,血磷控制在达标者并不是最好的,低磷者最差,提示控制血磷的方法,应强调药物降磷及充分透析,低磷的饮食应兼顾营养状况,钙磷代谢和营养状况同时达标对患者更有益。

Objective To know the situation of serum calcium and phosphorus achieved standard state in maintenance hemodialysis （MHD） patients through analyzing the clinical data of MHD patients in Kunming Blood Purification Center of the First Peoples＇s Hospital of Kunming City.To investigate nutritional status and short term prognosis in different serum phosphorus level groups of those MHD patients, so as to select appropriate method of serum phosphorus intervention.Methods 173 MHD patients were enrolled in this study.The indexes named serum phosphorus, serum calcium, intact parathyroid hormone （iPTH）, serum albumin （Alb）, cholesterol （TC）, and body mass index （BMI） were tested every three months for and continued six times.The average value for each index was calculated.Four groups were set up according to the average values of serum phosphorus： low phosphorus, standard phosphorus, high phosphorus, and ultra-high phosphorus groups, respectively.T-test, chi-square test and rank sum test were used to analyze the case fatality rate, nutritional status and other indexes.Logistic regression was used to analyze the related factors.Results Various indexes achieved standard rate in total 173 patients was 42.2% in serum phosphorus, 67.6% in serum calcium, 52.6% in iPTH, 67.6% in calcium-phosphorus product, 43.4% in ALB, 64.7% in TC and 60.7% in BMI, respectively.The serum phosphorus, calcium and iPTH together achieved standard rate was only 15.6% （27/173）.The case fatality rate of the four groups was the highest in the low phosphorus group （32.6%） and the lowest in the standard phosphorus group （10.9%）, but no statistically significant difference existed between them （P〉0.05）.The ALB level was the highest in the high phosphorus group （55.6%）, and the lowest in the low phosphorus group （15.8%）.As compared with standard phosphorus group, only the low phosphorus group has statistically difference was found （P〈0.05） for Alb in four groups.Univariate analysis showed that age, Ca, P, iPTH and TC were significantly related with the case fatality rate.Logistic regression analysis showed that only the age and TC had statistically significant correlation with case fatality rate.Conclusions In MHD patients, the incidence of serum calcium and phosphorus metabolism disorders and malnutrition is high.In view of the nutrition and serum calcium and phosphorus metabolism status, serum phosphorus control in standard state was not the best.It implies that the control method of serum phosphorus should be emphasized on the phosphorus reduction by drug and adequate dialysis.In the period of low phosphorus diet, the nutritional status should be taken into account.Both serum calcium and phosphorus metabolism and nutritional status achieved standard state is more beneficial to patients.