四川地区维持性血液透析人群慢性肾脏病矿物质与骨异常的多中心横断面研究

A multicenter cross-sectional study of chronic kidney disease-mineral and bone disorder in Sichuan province

目的:了解四川地区维持性血液透析(MHD)患者慢性肾脏病矿物质与骨异常(CKD-MBD)的患病率、各个指标达标率及其发病危险因素。方法:纳入四川地区15个血液透析中心MHD患者1 150例,搜集患者一般临床资料及实验室检查结果,以超声心动图、骨盆正位片、腹部侧位片评价血管钙化。检测血清25羟维生素D[25(OH)D]、25(OH)D3、成纤维细胞生长因子23(FGF-23)和血清可溶性klotho蛋白(s KL)。以K/DOQI指南建议的目标值为标准,分析CKD-MBD患病率、各项指标达标情况及相关危险因素。结果:1 150例MHD中诊断为CKD-MBD的患者1 113例(96.78%)。其中低血磷7.80%、高血磷55.90%;低血钙31.40%、高血钙28.30%、低甲状旁腺激素(PTH)17.20%、高PTH 58.30%;心脏瓣膜钙化的患者169例(30.02%);腹主动脉钙化患者168例(45.41%);髂股动脉钙化106例(27.46%)。患者血钙、血磷、血i PTH达标率分别为36.78%、36.30%、24.50%。收缩压、血清肌酐、血尿素氮、高密度脂蛋白、血i PTH与高磷血症独立相关。透析龄、血i PTH、血清FGF-23与高血钙独立相关。血磷、白蛋白、碱性磷酸酶(ALP)与高血i PTH独立相关。结论:四川地区的MHD患者的CKDMBD的患病率高,达标率低,受多种因素影响。

Objective： To explore the prevalence and risk factors of the chronic kidney disease-mineral and bone disorder（ CKD-MBD） in maintenance hemodialysis（ MHD） patients in Sichuan province. Methodology： A total of 1 150 patients on MHD from 14 hemodialysis centers in Sichuan province were enrolled in this study. Demographic information and laboratory measurements including serum calcium,phosphorus and PTH were collected. Vascular calcification was determined by echocardiogram and plain X-ray films of lateral abdomen and frontal pelvis. Serum levels of 25 hydroxyvitamin D（ 25（ OH） D）,25（ OH） D3,FGF-23 and serum soluble Klotho protein（ s KL） was also measured. Results： Among our patients,96. 8% patients met the diagnosis criteria of CKD-MBD. The prevalence of hypophosphatemia,hyperphosphatemia,hypocalcemia,hypercalcemia,decreased PTH and elevated PTH was 7. 80%,55. 9%,31. 4%,28. 3%,17. 2% and 58. 3%,respectively. Cardiac valve calcification was found in 169 patients（ 30. 0%）. X-ray films showed that abdominal aortic calcification was found in 168 patients（ 45. 4%）,iliac artery and femoral artery calcification was found in 106 patients（ 27. 5%）. The percentage of patients within treatment target of serum calcium,phosphorus and i PTH was 36. 8%,36. 3%and 24. 5%,respectively. Multivariate logistic regression analyses demonstrated that the risk factors for hyperphosphatemia were systolic pressure,SCr,BUN,HDL and i PTH; for hypocalcemia were dialysis duration,i PTH and FGF-23; for higher i PTH were phosphate,ALB and ALP; and those for vascular calcification were age,dialysis duration,pulse pressure,CRP and klotho. Conclusion： The prevalence of CKD-MBD in MHD patients in Sichuan area is high,and the control rate of serum phosphorus,calcium and i PTH is relatively low and attributed to multiple factors.