透析年限对尿毒症患者矿物质和骨代谢异常的影响

Effect of Dialysis Duration on Mineral and Bone Metabolism Abnormality in Uremia Patients

目的探讨不同透析年限的尿毒症维持血液透析患者骨转换生化标志物的差异。方法选取60例尿毒症患者,按照透析时间的不同,分为三组,初次接受透析的尿毒症患者为A组,血液透析年限在0~5年为B组,血液透析大于5年为C组,检测换血清中总I型前胶原氨基端延长肽与、TPINP、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、骨钙素、全段甲状旁腺素(i PTH)及血钙(Ca)、血磷(P)、25羟维生素D_3[25(OH)VD_3]相关生化指标,比较其差异,并研究相关性。结果所有患者TPINP、β-CTX、i PTH均显著升高,C组升高最显著,B组次之,A组较B、C两组低,三组之间比较,差异有统计学意义(P<0.05),三组患者25(OH)VD_3降低,C组下降的最显著,B组次之,A组较B,C两组值高,三组比较,差异有统计学意义(P<0.05);i PTH与TPINP、β-CTX、骨钙素之间呈正相关(P<0.05),与25(OH)VD_3呈负相关(P<0.01);(TPINP)和i PTH呈高度正相关。结论尿毒症维持血液透析患者均存在不同程度的矿物质和骨代谢异常,病程越长,矿物质及骨代谢紊乱程度越严重,普通血液透析透析不能改善其发展程度。

Objective To investigate the differences in biochemical markers of bone conversion in hemodialysis patients with uremia with different dialysate years. Methods 60 patients with uremia were divided into three groups according to the time of dialysis. The first dialysable uremia patients were group A, and the period of hemodialysis in group B was 0 to 5 years, and hemodialysis for more than 5 years was group C. The detection of serum procollagen type I amino terminal peptide, TPINP, and type I collagen carboxy terminal peptide sequence specifc beta （beta -CTX）, osteocalcin, parathyroid hormone （iPTH） and calcium （Ca）,phosphorus （P）, 25 hydroxyvitamin D3 [25 （OH） VD3] was conducted, the differences and the correlation was studied. Results TPINP, beta -CTX, iPTH was increased in all patients, and signifcantly higher in C group, then B group, A group was lower compared with B group, C group, the difference was statistically signifcant （P 〈 0.05）, 25 （OH） VD3 decreased in all patients, most signifcantly decreased in the C group, then B group, A group was higher compared with B group, C group, the difference was statistically significant （P 〈 0.05）. There was positive correlation between iPTH and TPINP, beta -CTX and Osteocalcin （P 〈 0.05） was negatively correlated with 25 （OH） VD3 （P 〈 0.01）. TPINP was highly correlated with iPTH. Conclusion Uremic maintenance hemodialysis patients have different degrees of mineral and bone metabolism abnormalities. The longer the course of disease is, the more serious the disorder of mineral and bone metabolism.