不同分期慢性肾脏病患者血清镁含量检测及其临床意义

Detection of serum magnesium in patients with different stages of chronic kidney disease and its clinical significance

目的探讨慢性肾脏病(CKD)患者各期血清镁水平变化规律,为临床指导工作提供一定的理论依据。方法选取2014年1月-2017年12月于解放军第474医院肾病科就诊的CKD患者103例为研究对象,根据患者的血清镁水平对患者进行分组,将所有患者分为低镁血症组、镁正常组及高镁血症组,根据肾小球滤过率(GFR)水平对慢性肾脏病患者进行CKD分期。分析患者的一般情况,比较CKD不同分期患者镁的特征分布。结果纳入研究对象共103例,男性59例,女性44例,男女比例为1.34∶1,年龄21～73岁,平均(52.4±14.9)岁。其中慢性肾脏病原发病为肾小球肾炎36例,占35.0%,高血压良性小动脉肾硬化19例,占18.4%,另外有糖尿病肾病27例,占26.2%,其它原发病占20.4%(21/103),随着CKD分期的进展,CKD1～2期血镁水平较低,CKD5期血镁水平最高,CKD患者血镁水平有上升趋势。CKD4期及CKD5期患者血镁含量高于CKD1～2期及CKD3期,差异有统计学意义(P<0.05)。CKD4期和CKD5期出现明显的镁代谢紊乱,低镁血症中以CKD4期所占比例最高,高镁血症以CKD5期所占比例更高。低镁血症组、镁正常组和髙镁血症组3组间TG、LDL-C、iPTH水平间经统计分析差异有统计学意义(P<0.05),高镁血症组TG、LDL-C、iPTH低于镁正常组和低镁血症组(P<0.05)。结论 CKDl～3期患者的血清镁水平相对比较稳定,在CKD4期血清镁水平开始出现升高,随着CKD分期的进展,出现了逐渐加重的镁代谢紊乱。

Objective To investigate the changes of serum magnesium levels in patients with CKD, and to provide a theoretical basis for clinical guidance. Methods A total of 103 patients with CKD who were admitted to the department of Nephrology of the 474 th Hospital of Chinese PLA from January 2014 to December 2017 were enrolled. The general information of all patients was collected. Triglyceride(TG), total cholesterol(CHOL), high density lipoprotein(HDL-C), low density lipoprotein(LDL-C), serum calcium(Ca), blood phosphorus(P), blood magnesium(Mg) were detected. The patients were divided into 3 groups according to the serum magnesium level of the patients. All patients were divided into hypomagnesemia group, magnesium normal group and hypermagnesemia group. Patients with chronic kidney disease were staged according to GFR level. The general condition of the patient and the characteristics of the laboratory indicators were analyzed to compare the characteristic distribution of magnesium in patients with different stages of CKD. Results A total of 103 subjects were enrolled in this study, including 59 males and 44 females. The male to female ratio was 1.34∶1, aged 21-73 years, with an average of(52.4±14.9) years old. Chronic kidney disease was caused by glomerulonephritis in 36 cases(35.0%), diabetic nephropathy in 27 cases(26.2%), hypertension in benign small arteriosclerosis in 19 cases(18.4%), and other primary diseases accounted for 20.4%(21/103). The blood magnesium level of CKD1-2 was lower, and the blood magnesium level of CKD5 was the highest. With the progression of CKD stage, the blood magnesium level of CKD patients had an increasing trend. The blood magnesium content of patients with CKD stage 4 and CKD stage 5 was higher than that of CKD stage 1-2 and CKD stage 3, the difference was statistically significant(P<0.05). There were obvious disturbances of magnesium metabolism in CKD4 and CKD5. The proportion of CKD4 was the highest in hypomagnesemia, and the proportion of hypermagnesemia was higher in CKD5. There were statistically significant differences in TG, LDL-C, and iPTH levels between the hypomagnesemia group, the magnesium normal group, and the dialysis group(P<0.05). The TG, LDL-C, and iPTH in the hypermagnesemia group were lower than those in the magnesium group(P<0.05). Conclusion Serum magnesium levels in patients with CKD remain relatively stable in CKD stage 1-3, and was increased in CKD4 stage. With the progression of CKD stage, magnesium metabolism disorder was gradually aggravated.