腹膜透析患者血镁水平及相关因素的分析

Analysis of serum magnesium level and related factors in peritoneal dialysis patients

目的:调查单个腹膜透析中心腹透患者的血镁水平,并比较不同血镁水平间腹透患者的人口统计学、透析状况、生化指标的差异。方法:对本腹透中心147例患者的人口学特征以及临床、实验室数据进行回顾性研究。按血镁浓度将其分为A组:Mg^(2+)<0.77 mmol/L,B组:0.77 mmol/L≤Mg^(2+)≤1.03 mmol/L,C组:Mg^(2+)>1.03 mmo/L。结果:A组血磷、钙、钾、尿素氮显著低于C组;B组血清白蛋白显著低于C组;A组血肌酐显著低于B和C组;B、C组尿素清除指数、标准化的肌酐清除率均显著低于A组;双变量相关性分析:血镁与血磷、钾、全段甲状旁腺激素呈正相关,而血镁与尿素清除指数、标准化的肌酐清除率呈负相关。另外,4种腹膜转运类型中,高转运组血镁浓度显著低于低平均转运组及低转运组(P<0.01)。结论:腹透患者存在着镁代谢异常,其中高镁血症发生率高于低镁血症。腹膜的转运能力高、透析充分性好的患者血镁浓度可能越低,另外血镁异常经常伴随着其他电解质及代谢紊乱,高镁血症患者血钙、磷、钾浓度可能也较高,血糖水平可能较低。

Objective： The aim of this retrospective study was to investigate serum magnesium level in peritoneal dialysis （PD） patients in a single PD center and to compare the differences of demographics, dialysis status, and biochemical parameters among PD patients with different magnesium levels. Methods： This study analyzed the demographic characteristics as well as clinical and laboratory measurements of 147 patients in our dialysis center. These patients were divided into three groups according to serum magnesium concentration： group A： Mg^2＋〈0.77 mmol/L, group B： 0.77 mmol/L≤ Mg^2＋≤1.03 mmol/L, group C： Mg^2＋〉1.03 mmo/L. Results ： For serum phosphorus, serum calcium, serum potassium, serum urea nitrogen of dialysis patients ： group A was significantly lower than group C ; serum albumin： group B was significantly lower than that in group C ; serum creatinine was significantly lower in group A than in group B and group C; for urea clearance index （Kt/V） and the standardized creatinine clearance rate： group B and group C was significantly lower than group A; The bivariate correlation analysis showed that serum magnesium was positively associated with serum phosphorus, and intact parathyroid hormone. Serum magnesium was also negatively associated with Kt/V and the standardized creatinine clearance rate. Moreover, our study found that the levels of serum magnesium were different in patients with different peritoneal transport characteristics which was divided by peritoneal equilibration test （P 〈 0.01 ）. Conclusion： There was an abnormal metabolism of magnesium in patients with PD. Among them, hypermagnesemia was more frequent than hypomagnesemia. Patients with lower serum magnesium concentration and high peritoneal transport capacity had better dialysis adequacy. Moreover, abnormal serum magnesium levels were often associated with other electrolyte and metabolic disorders. The levels of serum calcium, phosphorus and potassium may be higher and the serum glucose level may be lower in patients with hypermagnesemia.