维持性血液透析患者钙 磷及iPTH三项指标达标状况分析

Analysisof serum calcium,phosphorus and iPTH status inmaintenance hemodialysis patients

目的分析维持性血液透析(MHD)患者的钙、磷、全段甲状旁腺激素(iPTH)三项指标达标状况及其对MHD患者贫血、营养状况及血压等临床症状的影响。方法回顾性分析2017年1~12月在安徽医科大学第二附属医院血液透析中心行MHD(透析时间≥12个月)的192例患者临床资料。根据钙、磷、iPTH三项指标达标情况分成3组:一项达标组38例、二项达标组48例及三项达标组16例,比较三组患者血红蛋白(Hb)、血清白蛋白(ALB)及血压的差异。结果以改善全球肾脏病预后组织(KDIGO)指南为标准,本组患者钙、磷、iPTH达标率分别为55.2%、28.6%、59.4%,任意两项(钙和磷、钙和iPTH、磷和iPTH)共同达标率分别为12.6%、36.5%、17.7%,三项共同达标率为8.9%。任意两项指标达标的患者中,Hb、ALB达正常值的比例(54.2%、79.2%)明显高于一项达标组(50.0%、68.4%);三项均达标患者中,Hb、ALB达正常值的比例(87.5%、93.8%)明显高于两项达标组(54.2%、79.2%),差异均有统计学意义(P均<0.05);一项达标、二项达标及三项达标组3组间血压达正常值的比例比较,差异无统计学意义(P>0.05)。结论本中心MHD患者钙、磷、iPTH三项指标中磷达标率及三者均达标率有待进一步提高;钙、磷、iPTH均达标有利于MHD患者肾性贫血及营养状况的改善。

Objective To analysewhether the status of serum,phosphorus and intact parathyroid hormone(iPTH)reaches the standardin maintenance hemodialysis(MHD)patients,andits effects on clinical symptoms,such as anemia,nutrition,blood pressure,and so on,so as to provide reference for improving the management and therapeutic effect of CKD-MBD.Methods The clinical data of 192 MHD patients in the Hemodialysis Center of the Second Hospital of Anhui Medical University center(dialysis time over 12 months)from January2017 to December 2017 were retrospectively analysed.According to the status of serum,phosphorus and iPTHbased on the standard,the patients were divided into group of one index,twoindices andthreeindices based on the standard.The differencesin hemoglobin(HB),serum albumin(ALB)and blood pressure were compared in three groups.Results On the basis of KDIGO guidelines,the rate of reaching the standard of calcium,phosphorus and iPTH in MHD patients was 55.2%,28.6% and 59.4%,respectively.The rate of reaching the standard of two indices(calcium and phosphorus,calcium and iPTH,phosphorus and iPTH)was 12.6%,36.5% and 17.7%,respectively.The rate of reaching the standard of two indices was 8.9%.The proportion of Hb and ALB reaching normal value in any two indices group(54.2%,79.2%)was significantly higher than that in one index group(50.0%,68.4%),and the proportion of Hb and ALB reaching normal value in all three indices group(87.5%,93.8%)was markedly higher than that in two indices groups(54.2%,79.2%),and the difference was statistically significant(P<0.05).No statistical difference was detected in blood pressure normal rate among three groups(P>0.05).Conclu sion The rate of reaching the standard of phosphorus and the rate of reaching the standard of all three indices in MHD patients need to be further improved.Calcium,phosphorus and iPTH all reach the standard,which is beneficial to improve renal anemia and nutritional status of MHD patients.