腹膜透析患者低甲状旁腺素血症相关因素分析

Analysis of the risk factors for hypoparathyroidemia in peritoneal dialysis patients

目的探讨持续性不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者低甲状旁腺激素血症的患病率,分析腹膜透析患者血清全段甲状旁腺激素(intact Parathyroid Hormone,iPTH)降低可能的影响因素。方法于首都医科大学附属北京潞河医院腹膜透析中心汇百通患者管理系统数据库检索2016年1~12月间在透析的腹膜透析患者,规律CAPD透析3个月以上并排除未复诊者纳入本研究,详细记录患者一般情况及随诊信息并进行统计分析。结果共133例患者纳入研究,低iPTH血症患病率为56.39%,患者平均年龄为(62.50±13.33)岁,中位透析龄为26.37(13.39,44.88)月,低iPTH血症组患者年龄(Z=2.707,P=0.007),合并糖尿病的比例(χ~2=8.512,P=0.004),血钙(Z=2.588,P=0.010),随机血糖(Z=2.760,P=0.006)及二氧化碳结合力(t=2.667,P=0.008)显著高于iPTH水平未低下组,而透析龄(Z=2.419,P=0.032)、血磷水平(t=3.914,P<0.001)、血肌酐水平(t=3.272,P=0.001)、血白蛋白水平(Z=2.485,P=0.013),老年营养风险指数(Z=2.451,P=0.014)则明显低于iPTH水平未低下组。经多因素logistic回归分析显示,血钙升高(OR 145.062,95%CI 9.957~2113.463,P<0.001)是iPTH水平低下的独立危险因素。结论腹膜透析患者低iPTH血症患病率明显升高,糖尿病患者更易出现低iPTH血症,血钙升高是影响低iPTH血症的独立危险因素。

Objective To analyze the prevalence of low serum intact parathyroid hormone （iPTH） level and to evaluate the risk factors for the low serum iPTH in patients on continuous ambulatory peritoneal dialysis （CAPD）. Methods Patients with regular CAPD and followed up for more than 3 months in the Department of Nephrology, Beijing Luhe Hospital from January to December 2016 were enrolled in this study. They were retrieved from the Huibaitong medical database. Their general condition and follow-up information were recorded and analyzed. Results A total of 133 CAPD patients were included in this study. Their average age was （62.50＋13.33） years. The prevalence of hypoparathyroidemia was 56.39% in these patients. Their average dialysis duration was 26.37 （13.39, 44.88） months. Age （Z=2.707, P=0.007）, diabetes （Z2=8.512, P=0.004）, se- rum calcium （Z=2.588, P=-0.010）, random blood glucose （Z=2.760, P=-0.006） and carbon dioxide level （t=- 2.667, P=0.008） were significantly higher in hypoparathyroidemia patients than in non-hypoparathyroidemia patients; dialysis duration （2;=2.419, P=0.032）, serum phosphorus （t=3.914, P〈0.001）, serum creatinine （t=- 3.272, P=0.001）, serum albumin （Z=2.485, P=0.013） and geriatric nutritional risk index （Z=2.451, P=0.014） were significantly lower in hypoparathyroidemia patients than in non-hypoparathyroidemia patients. Logistic regression showed that higher serum calcium was the independent risk factor for hypoparathyroidemia （OR= 145.062, 95% CI 9.957~2113.463, P〈0.001）. Conclusions The prevalence of hypoparathyroidemia was higher in CAPD patients. Diabetic patients were more susceptible to have hypoparathyroidemia. Higher serum calcium was the independent risk factor for hypoparathyroidemia.