230例维持性血液透析患者矿物质和骨代谢紊乱及相关因素分析

Factors resulting in mineral and bone metabolism disorders in maintenance hemodialysis patients: an analysis of 230 cases

目的探讨维持性血液透析患者矿物质和骨代谢紊乱的相关影响因素。方法分析230例血液透析患者的血清钙、磷和全段甲状旁腺激素(i PTH)的水平,患者按3项指标分为达标组和未达标组,对一般资料和血生化指标等因素进行分析。结果 230例血液透析患者平均血清钙水平为2. 32±0. 22 mmol/L,平均血清磷水平为1. 87±0. 42 mmol/L,平均全段甲状旁腺激素水平为291. 7±206. 4 ng/L。达标组患者的高血压比例(58. 6%)低于未达标组(83. 1%),差异有统计学意义(P <0. 05);两组患者的平均年龄、性别、平均透析时间比较差异均无统计学意义(P> 0. 05)。两组患者血清血红蛋白、高敏C-反应蛋白水平、肌酐和尿素氮值比较差异有统计学意义(P <0. 05),白蛋白值比较差异无统计学意义(P> 0. 05)。结论维持性血液透析患者矿物质和骨代谢紊乱与肾功能恶化、贫血加重、微炎症状态和高血压相关。

Objective To find out the factors that result in mineral and bone metabolic disorders in maintenance hemodialysis patients. Methods The levels of serum calcium,phosphorus and intact parathyroid hormone（ i PTH） in 230 patients with hemodialysis were analyzed. The patients were divided into three groups according to three indexes. The general data and blood biochemical indexes were analyzed. Results The average serum calcium level in the subjects was2. 32 ± 0. 22 mmol/L. The average serum phosphorus level was 1. 87 ± 0. 42 mmol/L. The average serum i PTH level was291. 7 ± 206. 4 ng/L. The proportion of hypertension in the group meeting the standard（ 58. 6%） was lower than that in the group not meeting the standard（ 83. 1%）. The difference was statistically significant（ P〈0. 05）. No significant difference was observed in average age,sex and dialysis time between the two groups（ P〈0. 05）. Significant differences were observed in serum hemoglobin（ Hb）,high sensitivity C-reactive protein level（ hs-CRP）,creatinine（ Scr） and urea nitrogen（ BUN） between the two groups（ P〈0. 05）. No significant difference was found in albumin（ Alb） levels（ P〈0. 05）. Conclusions Mineral and bone metabolic disorders in maintenance hemodialysis patients are associated with deterioration of renal function,exacerbation of anemia,microinflammation and hypertension.