维持性血液透析患者低甲状旁腺激素血症的影响因素研究

Clinical study of low hypothyroid hormone in patients with maintenance hemodialysis

目的探讨维持性血液透析(MHD)患者低甲状旁腺激素血症的影响因素。方法选择MHD患者179例,按透析前的血浆全段甲状旁腺激素(iPTH)水平分为2组:A组(低甲状旁腺激素血症组)患者血清iPTH<150 pg/m;B组患者血清iPTH≥150 pg/mL。结果 179例MHD患者血iPTH平均浓度为(229.62±139.92)pg/mL,iPTH达标者83例(46.37%),低甲状旁腺激素血症63例(35.2%),高于标准者33例(18.43%)。A组患者与B组患者相比较,A组患者的年龄大、糖尿病发生率高、血清钙水平高,血清磷水平、血浆白蛋白水平低,其差异有统计学意义(P<0.05)。而2组患者在性别构成、透析龄、平均动脉压、血红蛋白、尿素氮、肌酐、服用钙剂、服用活性维生素D制剂等方面比较差异无统计学意义(P>0.05)。Pearson相关分析结果显示,MHD患者发生低甲状旁腺激素血症与患者年龄、患有糖尿病、血浆白蛋白水平、血清钙水平、血清磷水平等因素有相关性(P<0.05);Logistic回归分析结果显示,MHD患者的年龄和血清磷水平是发生低甲状旁腺激素血症的独立危险因素(P<0.05)。结论 MHD患者易发生低甲状旁腺激素血症,年龄和血清磷水平是MHD患者发生低甲状旁腺激素血症的独立危险因素。

Objective To investigate the influencing factors of hypothyroid hormone in patients with maintenance hemodialysis （MHD）. Methods According to the level of intact parathyroid hormone （iPTH）before dialysis, the patients 179 patients with MHD were divided into two groups：Group A,serum iPTH 〈 150 pg/mL（low serum iPTH group） ;group B,the serum iPTH acuity 〉 150 pg,/mL. Results The average concentration blood iPTH of 179 cases of MHD patients was （229.62 ± 139.92） pg/ml, iPTH compliance was 83 cases （46.37%）,low parathyroid hormone was 63 cases （35.2%）, the patients who were higher than the standard were 33 cases （ 18.43 % ）. Compared with group B, the age of group A was older, the incidence of diabetes was higher, the concentration of serum calci- um was higher, and the levels of serum phosphorus and plasma albumin were lower. The difference was statistically significant. There was no significant difference in gender composition, dialysis age, mean arterial pressure, urea, creatinine, hemoglobin, taking calcium and taking calcitriol. The Pearson correlation analysis showed that hypothyroidism in patients with MHD was associated with patient age, diabetes mellitus, serum calcium level, serum phosphorus level and plasma albumin level. Logistic regression analysis showed that the age of MHD patients and the serum levels of phosphorus were independent risk factors for hypoparathyroidism. Conclusion MHD patients prone to low parathyroid hormone levels, age and the level of serum phosphorus was the independent risk factors for low parathyroid hormone levels in MHD patients