维持性血液透析患者甲状旁腺激素水平及相关因素分析

Analysis of Parathyroid Hormone Levels and Related Factors in Maintenance Hemodialysis Patients

目的分析维持性血液透析(MHD)患者血清钙(Ca)、磷(P)、甲状旁腺激素(PTH)、尿素(Ur)、肌酐(Crea)、肾小球滤过率(e GFR)、总蛋白(Tp)、白蛋白(Alb)、收缩压、舒张压、脉压差、透析时间、糖尿病史及24小时(24h)尿量水平,探讨MHD患者PTH水平影响因素。方法纳入2017年2月至2018年2月我院血透中心行MHD患者324例。根据患者PTH水平分为低PTH组(PTH<150 pg/m L),正常PTH组(150 pg/m L≤PTH≤300 pg/m L)和高PTH组(PTH>300 pg/m L)。比较三组生化指标,并进行相关分析及多因素logistic回归分析。结果三组在年龄、性别、Ur、收缩压、脉压差、糖尿病史及24h尿量差异无统计学意义(P>0. 05)。PTH、Ca、P、Cr、e GFR、Tp、Alb、舒张压和透析时间在各组之间差异有统计学意义(P<0. 05)。Spearman相关分析显示:在MHD患者中,性别、e GFR及24h尿量与PTH水平呈负相关(r=-0. 136、-0. 166、-0. 119,P<0. 05),而P、Ur、Crea和透析时间与PTH水平呈正相关(r=0. 190、0. 143、0. 232,r=0. 181,P<0. 05)。多因素logistic回归分析显示:高磷血症和低钙血症是MHD患者发生PTH升高的危险因素,OR值分别为[OR=9. 677,95%CI(2. 599,36. 029),P=0. 001]和[OR=0. 025,95%CI(0. 002,0. 312),P=0. 004]。结论高磷血症是MHD患者发生PTH升高的主要危险因素,MHD患者应积极控制血磷水平,改善患者预后及生存质量。

Objective To analyze serum calcium(Ca),phosphorus(P),parathyroid hormone(PTH),urea(UR),creatinine(Crea),glomerular filtration rate(EGFR),total protein(Tp),albumin(Alb),systolic pressure,diastolic pressure,pulse pressure difference,dialysis time,diabetes mellitus history and 24 hours urine volume in maintenance hemodialysis(MHD)patients,and the factors influencing the PTH level in MHD patients were discussed.Methods 324 cases of MHD patients,from 2-2017 to2-2018 at the blood transmittance Center of West China Hospital of Sichuan University,were included.According to the PTH level,the patientswere divided into low PTH Group(PTH﹤150 pg/ml),normal PTH Group(150 pg/mL≤PTH≤300 pg/mL)and high PTH group(PTH >300 pg/ml).The biochemical indexes of three groups were compared,and the correlation analysis and multi-factor logistic regression were analyzed.Results There was no significant difference in age,sex,Ur,systolic pressure,pulse pressure difference,diabetes mellitus history and 24h urine volume among the three groups(P >0.05).There were statistically significant differences between PTH,Ca,P,Cr,EGFR,Tp,Alb,diastolic pressure and dialysis time among the three groups(P﹤0.05).Spearman correlation analysis showed that in MHD patients,sex,eGFR and 24h urine volume were negatively correlated with PTH level(r=-0.136,r=-0.166,r=-0.119,P﹤0.05),while P,Ur,Crea and dialysis time were positively correlated with PTH level(r=0.190,r=0.143,r=0.232,r=0.181,P﹤0.05).Multi-Factor Logistic regression analysis showed that hyperkalemia and hypocalcemia were risk factors for increased PTH in MHD patients,and OR values respectively were 9.677[95%CI(2.599,36.029),P=0.001]and 0.025[95%CI(0.002,0.312),P=0.004].Conclusion Hyperkalemia is the main risk factor for the increase of PTH in MHD patients,and MHD patients should actively control the blood phosphorus level to improve the patients prognosis and life quality.